Conventional ultrafiltration for cardiac surgery fails to prevent postoperative pulmonary complications

Postoperative pulmonary complications increase mortality following cardiac surgery. Conventional ultrafiltration may reduce pulmonary complications by removing mediators of bypass-induced inflammation and countering hemodilution. We tested the primary hypothesis that conventional ultrafiltration reduces postoperative pulmonary complications, and secondarily, improves early pulmonary function assessed by the ratio of arterial partial pressure to fractional inspired oxygen concentration.

This retrospective analysis compared the incidence of postoperative pulmonary complications in adult patients who underwent cardiac surgery with and without the use of conventional ultrafiltration using logistic regression with adjustment for confounding variables. The primary outcome was a composite of reintubation, prolonged ventilation, pneumonia or pleural effusion. Secondarily, we examined early postoperative lung function using a quantile regression model. We also explored whether red blood cell transfusion differed between groups.

RESULTS

Of 8026 patients, 1043(13%) received conventional ultrafiltration. After adjustment for confounding variables, the incidence of the composite primary outcome was higher in the conventional ultrafiltration group, with an estimated odds ratio of 1.25

The median [quantiles] arterial partial pressure to fractional inspired oxygen concentration ratio was 373[303, 433] vs 368[303, 428] with the estimated adjusted difference in medians of 5

The estimated odds ratio of intraoperative transfusion was 1.38 and for postoperative transfusion was 1.30

Use of conventional ultrafiltration was not associated with a reduction in the composite of postoperative pulmonary complications or improved early pulmonary function. We found no evidence of benefit from use of conventional ultrafiltration during cardiac surgery.

Reference:

Alfirevic A, et al "Association of conventional ultrafiltration on postoperative pulmonary complications" Ann Thorac Surg 2023; DOI: 10.1016/j.athoracsur.2023.02.056.