Perfusion
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Review
Specific requirements for bloodless cardiopulmonary bypass in neonates and infants; a review.
A miniaturized cardiopulmonary bypass circuit enables the safe performance, in selected pediatric patients, of bloodless open heart surgery. As the latest survival rates in neonatal and infant cardiac surgery have become satisfactory, investigators have concentrated upon the improvement of existing procedures. ⋯ This review reflects upon the selective, most relevant requirements for success of asanguinous neonatal and infant CPB: acceptable level of hemodilution during the CPB, patient preoperative hematocrit value and volume of CPB circuit. We present an assessment of practical measures that were also adapted in our institution to achieve an asanguinous CPB for neonatal and infant patients.
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Randomized Controlled Trial
Clinical relevance of ventilation during cardiopulmonary bypass in the prevention of postoperative lung dysfunction.
The current clinical study is the continuity of previous experimental findings in which ventilation during cardiopulmonary bypass (CPB) prevented reperfusion injury of the pulmonary arterial tree as demonstrated by preservation of vasorelaxation to acetylcholine (ACh) in swine. The aim of this prospective randomized study is to determine: 1) if ventilation during CPB prevents the selective endothelium-mediated lung dysfunction in humans and, 2) the clinical relevance of ventilation during CPB. Forty patients scheduled for primary coronary artery bypass grafting (CABG) were randomized into two groups: Group 1: Usual care (defined as no ventilation during CPB) and Group 2: CPB with low tidal volume ventilation (3 ml.kg(-1)) without positive end expiratory pressure (PEEP). ⋯ The ventilated group appears to obtain a greater vasorelaxation to ACh, as shown by the more pronounced change in PVRI when compared to the non-ventilated group. However, the difference in PVRI between the two groups was not statistically significant after weaning (p= 0.32) and 1hr after CPB (p= 0.28). Contrary to our hypothesis and due to larger than expected variability in the data, the hemodynamic and clinical changes seen were not statistically significant.