Artificial organs
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Multisite near infrared spectroscopy (NIRS) monitoring during pediatric cardiopulmonary bypass (CPB) has not been extensively validated. Although it might be rational to explore regional tissue saturation at different body sites (namely brain, kidney, upper body, lower body), conflicting results are currently provided by experience in children. The aim of our study was to evaluate absolute values of multisite NIRS saturation during CPB in a cohort of infants undergoing pediatric cardiac surgery to describe average differences between cerebral, renal, upper body (arm), and lower body (thigh) regional saturation. ⋯ Average cerebral NIRS values of patients who did not undergo circulatory arrest (CA) during CPB, 10 min after CPB weaning, were associated with average CI values with a significant correlation (r = 0.7, P = 0.003). In conclusion, during CPB, cerebral NIRS values are expected to remain constantly lower than somatic sensors, which instead tend to show similar elevated saturations, regardless of their position. Based on these results, positioning of noncerebral NIRS sensors during CPB without CA may be questioned.
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To evaluate the performance and safety of a newly developed blood warmer (ThermoSens), we tested its heating capability under various conditions using isotonic saline and hemolysis analysis with swine blood. The following two in vitro tests were performed: (i) To investigate the performance of the device, the inflow and outflow temperatures were measured at various flow rates (30, 50, and 100 mL/min) using cold (5°C) and room temperature (20°C) isotonic saline (0.9%). Several parameters were measured including the highest temperature of the outlet, the time required to reach the highest temperature, and the temperature of the intravenous line. (ii) To investigate the safety of the device, a hemolysis test was performed using swine blood. ⋯ The ThermoSens blood warmer warms isotonic saline effectively, reaching temperatures up to 36°C under various conditions. Hemolysis tests showed no RBC damage. Therefore, the newly developed ThermoSens has good heating performance and is safe for RBC products.
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This study investigated the total hemodynamic energy (THE) and surplus hemodynamic energy transmission (SHE) of a novel adult extracorporeal life support (ECLS) system with nonpulsatile and pulsatile settings and varying pulsatility to define the most effective setting for this circuit. The circuit consisted of an i-cor diagonal pump (Xenios AG, Heilbronn, Germany), an XLung membrane oxygenator (Xenios AG), an 18 Fr Medos femoral arterial cannula (Xenios AG), a 23/25 Fr Estech RAP femoral venous cannula (San Ramon, CA, USA), 3/8 in ID × 140 cm arterial tubing, and 3/8 in ID × 160 cm venous tubing. Priming was done with lactated Ringer's solution and packed red blood cells (HCT 36%). ⋯ The attributes of the XLung membrane oxygenator include low resistance, low energy loss, and low pressure drops at all flow rates and differential speed values. The arterial cannula created the highest pressure drop of all components of the circuit. Pulsatile flow improved the transmission of hemodynamic energy to the pseudo patient without significantly affecting the pressure drops across the circuit.
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Acute kidney injury (AKI) is a major cause of mortality and morbidity in hospitalized patients. Incidence and mortality rates vary from country to country, and according to different in-hospital monitoring units and definitions of AKI. The aim of this study was to determine factors affecting frequency of AKI and mortality in our hospital. ⋯ This study shows that KDIGO criteria are more sensitive in determining AKI. Mortality was not correlated with staging based on RIFLE or KDIGO. Nonetheless, our identification of urine output as one of the independent determinants of mortality suggests that this parameter should be used in assessing the correlation between staging and mortality.
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To evaluate the feasibility of implementing a cardiac assist system in a nonuniversity hospital we analyzed 18 consecutive patients treated with venoarterial membrane oxygenation. The system was used electively in 5/18 (27.8%) patients during high-risk interventions. Thirteen patients (72.2%) were treated in emergency situations. ⋯ In 9/13 (69.2%) emergency patients the system was removed successfully. The 60-day survival rate of the emergency patients was 53.8% (7/13). Our experience confirms that an innovative extracorporeal circulatory support system can be implemented in a nonuniversity hospital at a tolerable risk and a low complication and high procedural success rate.