Removal of prostaglandin E2 and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery

ObjectiveWe investigated the relationship between serum prostaglandin E2 and intraoperative blood pressure in pediatric cardiac surgery with modified ultrafiltration.MethodsIn 35 consecutive patients (31.6 ± 26.8 months, 0.4–111 months, 10.9 ± 5.5 kg, 2.9–23.8 kg) who underwent cardiac surgery with modified ultrafiltration, we measured intraoperative serum prostaglandin E2 changes and effluent prostaglandin E2, assessed the relationship between serum prostaglandin E2 and intraoperative hemodynamic parameters, and performed subset analyses to compare patients with low (<10 kg, n = 18) and high (>10 kg, n = 10) weights.ResultsDuring cardiopulmonary bypass, systolic blood pressure decreased from 80.8 ± 15.2 to 60.5 ± 11.3 mm Hg (P = .00000002979) and serum prostaglandin E2 increased from 16.6 ± 8.7 to 58.8 ± 53.3 pg/mL (P = .002). During modified ultrafiltration, although central venous pressure and catecholamine dosage transited at the same levels, systolic blood pressure increased from 60.5 ± 11.3 to 83.4 ± 14.1 mm Hg (P = .00000002979) and serum prostaglandin E2 decreased from 58.8 ± 53.3 to 21.1 ± 11.6 pg/mL (P = .001), with negative correlation between serum prostaglandin E2 and systolic blood pressure (R = −0.392, P = .0000277723) and 15,700 ± 10,700 pg (1790 ± 2230 pg/kg) prostaglandin E2 removed during modified ultrafiltration. Decrease in serum prostaglandin E2 was significantly higher in low-weight patients (51.8 ± 58.4 pg/mL) than in high-weight patients (15.7 ± 30.1 pg/mL).ConclusionRemoval of prostaglandin E2 is one reason for increased blood pressure during modified ultrafiltration, with the effect more marked in low-weight patients.