Objective: To assess the clinical effects and safety of modified ultrafiltration during pediatric cardiac surgery.
Methods: The clinical trials were located through electronic searches of the Cochrane Library (Issue 2, 2009), PubMed (1991 to April 2009), EMBASE (1991 to April 2009), China National Knowledge Infrastructure (CNKI, 1994 to April 2009), VIP (1991 to April 2009) and China Biomedicine Database (CBM, 1991 to April 2009), with the languages limited in English and Chinese. In strict accordance with the inclusion and exclusion criteria of the studies, two authors independently evaluated the quality of the included studies. Meta analysis of the studies was conducted using RevMan5.0 software, and the studies that could not be combined was analyzed descriptively.
Results: A total of 9 trials involving 587 patients were included. The results showed that compared with the group without ultrafiltration, the modified ultrafiltration group was superior in duration of postoperative mechanical ventilation [MD=-3.66, 95%CI (-6.02, -1.29), P=0.002] and showed no significant differences from the conventional ultrafiltration group [MD=-3.21, 95%CI (-6.90, 0.49), P=0.09]. Compared with balanced ultrafiltration group, the mechanical ventilation time, intensive care unit (ICU) monitoring time and the results of chest drainage in children were similar. Compared with the group receiving conventional or balanced ultrafiltration alone, the combined group of modified ultrafiltration had similar ventilation time [MD=-2.34, 95%CI (-6.74, 2.07), P=0.30] and ICU time [MD=-0.12, 95%CI (-0.31, 0.06), P=0.19]. The included studies reported no ultrafiltration-related complications.
Conclusion: Modified ultrafiltration improves the clinical outcomes of patients undergoing cardiopulmonary bypass during pediatric cardiac surgery, but the current evidence has not been sufficient to support the notion that the modified ultrafiltration achieves better clinical results than conventional or balanced ultrafiltration.