Perfusion
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Cardiopulmonary bypass (CPB) is associated with an accumulation of total body water and a systemic inflammatory response syndrome (SIRS), which, in turn, is associated with organ dysfunction and postoperative morbidity. It has been suggested that modified ultrafiltration (MUF) may be capable of reducing SIRS and improving clinical outcome by filtering out the inflammatory mediators generated during CPB. This paper reviews the data regarding the use of MUF in paediatric and adult settings. Specifically, three issues will be considered: 1) Does MUF improve clinical outcome? 2) Does MUF reduce the systemic inflammatory response to cardiac surgery with CPB? 3) Is MUF more effective than conventional ultrafiltration in improving clinical outcome?
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Clinical Trial Controlled Clinical Trial
Selection of optimal quantity of hydroxyethyl starch in the cardiopulmonary bypass prime.
Ringer's solution prime reduces colloid osmotic pressure and causes edema during cardiopulmonary bypass, while hydroxyethyl starch (HES) can be used to attenuate this effect. Fifty patients were classified into five equal groups: Group I (preoperative patients) is the control group and the other four groups (II, III, IV, V) received different volume ratios of Ringer's solution to HES (1:0, 2:1, 1:2, 0:1, respectively). ⋯ The results showed a reduction in interstitial fluid (ISF) expansion, changes in blood rheologic properties with the increase in HES quantity and shorter ventilation and recovery times in Groups IV and V. We concluded that the optimal HES quantity in the prime is two thirds, which insures an 85% reduction of ISF relative to Group II, shorter ventilation and recovery times and avoidance of the hazards of high levels of HES.