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Effect of peritoneal dialysis on intra-abdominal pressure and cardio-respiratory function in infants following cardiac surgery

  • Kevin P. Morris (a1), Warwick W. Butt (a1) and Tom R. Karl (a2) (a3)

Abstract

Objective: To investigate the relationship between dialysate volume, intra-abdominal pressure, and cardio-respiratory function in infants following cardiac surgery. Design: Prospective pilot study. Setting: Paediatric intensive care unit. Patients: Six infants undergoing peritoneal dialysis within 24 h of cardiopulmonary bypass. Interventions: Manipulation of the volume of dialysate at levels of 0, 10, 20, and 30 ml/kg in variable order. Measurements and main results: Intra-abdominal pressure was measured at each volume of dialysate via a pressure transducer connected to the dialysis catheter. Haemodynamic data was collected, including cardiac output, which was measured by thermodilution via a 3.5-French gauge catheter placed in the pulmonary arterial pathway. Respiratory data included PaO2, PaCO2, and dynamic compliance. Intra-abdominal pressure increased with increasing volume of dialysate (p < 0.001), though there was considerable variation between patients in the magnitude of increase. Intra-abdominal pressure remained low even with 30 ml/kg in the abdomen. In three infants, intra-abdominal pressure was re-measured in the absence of muscle relaxants, and was found to be higher in each case. No negative effects on cardiac output, markers of delivery of oxygen, or respiratory function were seen even at volumes of 30 ml/kg. Cardiac index was significantly higher with 10 ml/kg than when the abdomen was empty or contained a larger volume (p < 0.05). Conclusions: In this small group of infants, intra-abdominal pressure increased with increasing volumes of dialysate but remained low, even with 30 ml/kg in the abdomen, and was not associated with any deleterious effects on cardio-respiratory performance.

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Corresponding author

Correspondence to: Dr Kevin Morris, Paediatric Intensive Care Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. Tel: +0121 333 9673; Fax: +0121 333 9651; E-mail: kevin.morris@bch.nhs.uk

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