Question

summarize/Paraphrase in your own words

Infants are at high risk for fluid overload after cardiac surgery secondary to impaired hemodynamics, acute kidney injury (AKI), and capillary leak. Fluid overload is commonly self-limited and often marginalized as an expected stage in recovery. However, studies have shown that overload is associated with worse outcomes in critically ill patients.^1-3 Among infants after cardiac surgery, fluid overload independently predicts mortality and morbidity.

The paradigm of early renal replacement therapy has gained attention as studies have demonstrated associations with lower mortality and improved outcomes after cardiac surgery.^7-11 Among infants, peritoneal dialysis (PD) is the most common modality of dialysis, proven to be a safe method of fluid removal.^7,9,12-14 A previously published retrospective study¹³ demonstrated that PD is associated with improved outcomes, including duration of mechanical ventilation. However, to our knowledge, PD has not been compared prospectively with diuretic administration, the traditional postoperative therapy in the context of oliguria.

In this randomized clinical trial, we aimed to determine whether the modality of fluid removal (PD vs a standardized furosemide regimen) is associated with fluid balance and clinical outcomes. We hypothesized that, compared with infants receiving furosemide, infants randomized to PD would be more likely to have a negative fluid balance on postoperative day (POD) 1, would be less likely to develop 10% fluid overload, would have less time to negative fluid balance, and would have superior clinical outcomes, including duration of mechanical ventilation, length of stay, vasoactive infusion use, electrolyte level abnormalities, oxygenation indices, and mortality.

Answer 1

Fluid overload is quite common and serious problem in critical infants after cardiac surgery that affect morbidity and mortality among them. According to studies, peritoneal dialysis has proved an effective intervention to create negative balance in them and it improves patient outcomes as well. But due to lack of comparative study on effectiveness of PD and furosemide.we are conducting a randomised controlled trial with hypothesis of having better outcome among infants recieving furosemide in terms of duration of mechanical ventilation, length of stay, vasoactive infusion use, electrolyte level abnormalities, oxygenation indices, and mortality.