The Annals of thoracic surgery
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Pulsatile perfusion during cardiopulmonary bypass (CPB) has been reported to have a number of beneficial effects, including attenuation of hormonal stress responses and improved organ blood flow and function. To determine the effect of pulsatile perfusion on temperature gradients and the time required for cooling and rewarming during CPB, we studied 21 patients scheduled for elective coronary artery operations. The patients were divided into two comparable groups: Group 1 (N = 11) had standard nonpulsatile perfusion, while in Group 2 (N = 10), a pulsatile pump was used. ⋯ There were no significant differences in temperature measurements between groups except briefly during rewarming when finger skin temperature rose more rapidly in Group 1 (p less than 0.05). Temperature changes following CPB were the same for both groups, with rectal and esophageal temperatures showing an inverse relationships. These data demonstrate that pulsatile flow does not substantially alter rewarming time or temperature gradients during hypothermic CPB.
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A safe technique of pericardial aspiration is described for patients who have undergone a cardiac operation. A 6.875 cm thin-walled 18 gauge needle, flexible guidewire, and fenestrated central venous catheter are employed.
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Pulmonary alveolar proteinosis can result in severe hypoxemia. Treatment of symptomatic patients using unilateral or lobar staged lung lavage often results in improved oxygenation and functional capacity. ⋯ Oxygenation was markedly improved immediately following the procedure. Extracorporeal membrane oxygenation permits satisfactory respiratory support in the setting of severe respiratory failure and should be considered an adjunct for treatment of pulmonary alveolar proteinosis when lung lavage cannot be otherwise safely accomplished.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clinical comparison of hetastarch and albumin in postoperative cardiac patients.
Hetastarch, 6% hydroxyethyl starch solution, is an artificial colloid proposed for use as a volume expander. There is concern that hetastarch, like dextran, may adversely affect coagulation. To compare the effects of hetastarch with 5% albumin in postoperative patients, 60 consecutive patients who underwent coronary artery bypass were prospectively randomized into two study groups. ⋯ The mean volume of chest tube drainage did not differ between the groups (Group 1, 495 +/- 216 ml; Group 2, 637 +/- 402 ml; not significant), and no patient required reexploration for bleeding. Eighteen percent of Group 1 and 15% of Group 2 patients received banded blood during their hospitalization and required similar amounts (Group 1, 0.37 unit per patient; Group 2, 0.36 unit per patient; not significant). The use of hetastarch as a postoperative volume expander after myocardial revascularization is safe and effective, and results in substantial financial savings.
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Hetastarch, a synthetic colloid osmotic plasma volume expander, was employed in a prime for cardiopulmonary bypass in 37 patients undergoing myocardial revascularization. Comparison of laboratory values to those of 42 patients undergoing myocardial revascularization using an albumin-containing prime showed lower postoperative platelet counts (p less than 0.02) with hetastarch. There were no differences in chest tube drainage, blood use, plasma hemoglobin, fibrinogen levels, of coagulation times. The hetastarch prime cost $119.50 per patient, whereas the albumin-containing prime cost $321.35 per patient.