Perfusion
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Case Reports
Pulse wave analysis to assess systemic blood flow during mechanical biventricular support.
Measurement of systemic blood flow is of crucial importance in patients on mechanical circulatory support (MCS). We reported the case of a 65-year-old female patient in severe cardiogenic shock undergoing left (Jarvik 2000 axial flow pump) and right (Levitronix-Centrimag centrifugal pump) ventricular assist device implant. Evaluation of blood flow was obtained by ultrasonic flowmetry, continuous thermodilution technique, and pressure recording analytical method (PRAM). ⋯ At a Jarvik pump speed > or = 11000 rpm, the aortic valve did not open and PRAM did not provide blood flow values due to nonpulsatile blood flow. The present paper describes the first experience with PRAM in a single patient on MCS. Further studies are required to assess the validity of PRAM as an additional monitoring system in the setting of ventricular assist device support.
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Randomized Controlled Trial
Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass--a randomised controlled trial.
Perioperative volume replacement after cardiopulmonary bypass is complicated by post-bypass systemic inflammatory process. The aim of this study was to assess the effects of using two different colloid solutions as priming fluids in cardiopulmonary bypass. The study's primary end point was to measure the amount of fluid replacement needed during and post-cardiopulmonary bypass; blood loss, change in blood profile and intraocular pressure were secondary end points, used as measures of plasma oncotic pressures. ⋯ However, it showed an increase in intraocular pressure in both groups once cardiopulmonary bypass commenced. The average intraocular pressure was higher in the Gelofusine group compared to the Voluven group. The significant increase in intraocular pressure measurements in the Gelofusine group compared to the Voluven group support the hypothesis that Voluven maintains the plasma oncotic pressure better and reduces fluid shift.
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Extracorporeal life support (ECLS) was established in a newborn infant diagnosed with severe respiratory failure secondary to complex congenital heart disease. After 4 days of ECLS support in the intensive care unit, the infant was brought to the operating room for repair of the primary lesion. Due to concerns related to recurrent respiratory failure associated with blood contact to a new extracorporeal circuit, the existing ECLS circuit was modified for use in the operating room. This report describes the circuit modification steps and challenges related to running a modified ECLS circuit for cardiopulmonary support during cardiac surgery.