MODIFIED ULTRAFILTRATION IN ADULT CARDIAC SURGERY IS IT REALLY BENEFICIAL?

A POSPECTIVE RANDOMIZED CLINICAL TRIAL

Abstract

Background: Cardiopulmonary bypass initiates systemic inflammatory
response syndrome (SIRS) causing deleterious effects on various body systems with increased morbidity. Modified
ultrafiltration (MUF) is a technique that removes excess water and inflammatory mediators from the circulation in the
post-bypass period resulting in reduced bleeding, less blood transfusion requirements and overall reduced morbidity.
Materials and Methods: 96 patients were randomly selected and divided into two groups. In Group I called MUF group
(n=50), modified ultrafiltration was carried out for 15 min in the post bypass period. Group II called NON-MUFgroup
(n=46), MUF was not carried out. Clinical assessment was based on ASA class. Mean cardiopulmonary bypass and
aortic cross clamp times were 95.42 &56.94 min and 77.98 & 43.64 min in the MUF & NON-MUF groups respectively.
Variables were expressed as mean and percentage. In the MUF group , there was increase in Hb by more than 2g/dl
in 32 patients (64%) whereas in the NON-MUF group, this increase was only in 12 patients (20%). Mean postoperative
chest drainage was far less (422 ml) in MUF group as compared to NON-MUF group (842.50 ml).Transfusion
(449.12ml Vs 996.58 ml) and postoperative ventilatory requirements(40% Vs 47.8%) were also less in MUF group than
NON-MUF group. Inotropic support was nearly comparable in both the groups but overall morbidity (Low cardiac output
state, sepsis, reopening) was less in the MUF group (18%) as compared to NON-MUF group (30%). Mean ICU stay
was also less in MUF group (mean 51.52 hrs) than in NON-MUF group (mean 55.43 hrs). One patient in each group
died. Conclusion: Modified Ultrafiltration is associated with improved hemoglobin, less postoperative bleeding,
reopening and transfusion requirements with overall reduced morbidity and ICU stay. However, the need for inotropes
were not significantly different in the two groups.