The International journal of artificial organs
-
Review
Generation, detection and prevention of gaseous microemboli during cardiopulmonary bypass procedure.
Neuropsychological injury after cardiopulmonary bypass (CPB) is one of the most serious and costly complications arising from the procedure. Gaseous microemboli (GME) have long been implicated as one of the principal causes. There are two major sources of GME: surgical and manual manipulation of the heart and arteries; and the components of the extracorporeal circuit, including the type of pump, different perfusion modes, the design of the oxygenator and reservoir, and the use of vacuum assisted venous drainage (VAVD), all of which have a great impact on the delivery of existing GME to the patients. ⋯ Improvements in perfusion equipment and in perfusion and surgical techniques have led to a dramatic reduction in the occurrence of GME during cardiac surgery. Although the clinical relevance of cerebral air embolization in causing neurological damage is unclear, every single person involved in perfusion and surgical technology should be aware of the risk of embolization and strictly regulate clinical behavior. Related research should also be done to improve the design of circuit components and clinical practice with a view to eliminating air bubbles during CPB procedure.
-
Comparative Study
A comparison of the Niagara™ and Dolphin® catheters for continuous renal replacement therapy.
The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT); specifically, a new surface-modified catheter has been reported to possibly prevent thrombosis and catheter malfunction. ⋯ The Niagara and Dolphin catheters appear to be broadly equivalent in terms of their impact on circuit life.
-
Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal membrane oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. ⋯ ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.
-
Comparative Study
Acute kidney injury due to rhabdomyolysis in narcotic drug users.
Regular or illegal drugs and toxins are the most frequent non-physical causes of rhabdomyolysis (RM) in peacetime. Acute kidney injury (AKI) is a serious and, sometimes, fatal complication of RM. It occurs in 8-20% of RM incidents. ⋯ The results of this study suggest that both RM and ARF are more severe in HU than in NHU possibly due to an additional myotoxic effect of heroin.
-
Although nafamostat mesilate, a synthetic serine protease inhibitor, has been commonly used in Japan as an anticoagulant during continuous renal replacement therapy (CRRT), its clinical utility has not been well determined. The aim of this study was to evaluate the efficacy (filter survival) and safety (bleeding complications) of nafamostat mesilate in CRRT for acute kidney injury (AKI) among critically ill patients. ⋯ Nafamostat mesilate provided sufficient filter survival without causing major bleeding complications despite the prolongation of APTT.