Artificial organs
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Randomized Controlled Trial
Preoperative intravenous hydration confers renoprotection in patients with chronic kidney disease undergoing cardiac surgery.
Patients with chronic kidney disease (CKD) are at risk to develop acute renal failure (ARF) after open heart surgery. This complication is associated with high morbidity, mortality, and cost. Because the ability to concentrate urine is lost early in the progression of CKD, renal patients kept on fluid restriction prior to surgery may develop severe dehydration, a situation consistently found to be one of the most critical risk factors for postoperative ARF. ⋯ Four patients in the control group (27%), but no one in the hydration group, required dialysis after the operation (P < 0.01). Peak creatinine and blood urea nitrogen values were two to three times higher in the control group than in the hydration group. Preoperative intravenous hydration may ameliorate renal damage in patients with moderate-to-severe renal insufficiency undergoing cardiac surgery.
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Distal venous drainage during extracorporeal membrane oxygenation (ECMO) via femoral cannulation is described. It was performed to relieve distal venous congestion due to obstruction by the venous cannula. ⋯ Its effectiveness was confirmed by clinical examination and Doppler ultrasound in a patient presenting with acute myocarditis. In addition to distal limb perfusion during ECMO, this technique appears safe and simple for adequate distal limb drainage, and can be useful in cases where a change of cannulas is not possible.