Perfusion
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Multicenter Study Clinical Trial
Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?
Myocardial protection is performed using diverse cardioplegic (CP) solutions with various combinations of chemical and blood constituents. Newer CP formulations that extend ischemic intervals may require greater asanguineous volume, contributing to hemodilution. ⋯ In patients undergoing cardiac valve surgery, the type of CP did not have a strong clinical impact on hemodilution or transfusion. Choice of a myocardial preservation solution can be made independently of its effect on intraoperative Hct.
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Patients requiring V-A ECMO who receive femoral cannulation have an associated risk of distal, lower-limb hypoperfusion and ischemia of the cannulated leg. This pilot study evaluated the usefulness of non-invasive lower-limb oximetry, using near-infrared reflectance spectroscopy (NIRS) to detect limb ischemia. ⋯ Advancements in NIRS technology seem to have improved its accuracy for continuous, non-invasive monitoring of regional tissue and may provide clinicians with an additional metric to protect the distal portion of the cannulated leg.
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Postoperative delirium is the most common neurological complication of cardiac surgery. Hypoxia has been shown to increase the risk of postoperative delirium. The possibility to continuously monitor oxygen delivery (DO2) during cardiopulmonary bypass (CPB) offers an adequate approximation of the oxygen status in a patient. This study investigates the role of oxygen delivery during cardiopulmonary bypass in the incidence of postoperative delirium. ⋯ A low DO2i during cardiopulmonary bypass is significantly associated with the incidence of postoperative delirium in CABG patients. However, the role of DO2 as an independent predictor of delirium could not be proven.