Perfusion
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Over the last few years, near-infrared spectroscopy (NIRS) has been introduced to study cerebral haemodynamics and oxygenation. This paper points out how the use of an external source of CO2 effects on the absolute value of cerebral NIRS during cardiac surgery on cardiopulmonary bypass. ⋯ Nowadays, NIRS is usually used in cardiac surgery to reduce possible risks of neurological damage. The importance of the role of pCO2 in the cerebral vascular resistance and in cerebral blood flow has already been proven. This research demonstrates a relationship between pCO2 and the NIRS value. This paper could introduce an important correcting tool when an inadequate NIRS value occurs although the level of oxygenation, haematocrit and mean arterial pressure are acceptable and the arterial line is accurately positioned.
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Given that micelles of lipids are colloids, the hypothesis was generated that the rapid administration of large volumes of soybean oil micelles would be an effective perfusion fluid. We also hypothesized that oxygen loading would be enhanced due to the greater solubility of oxygen in lipids compared to water. ⋯ (1) Soybean oil emulsions were superior to other fluids in restoring and maintaining the blood pressure; (2) oxygen-carrying ability of soybean oil micelles exceeds that of water and follows Henry's law between 10% and 30% w/v oil content; (3) nitric oxide was carried by the micelles; (4) animals receiving soybean oil micelles did not exhibit fat embolization; (5) colloids comprised of soybean oil-containing micelles may be used to replace blood loss and may be used to deliver oxygen and other potentially therapeutic gases such as nitric oxide to tissues.
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Clinical Trial
Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation.
Red blood cell (RBC) transfusion is used in the critically ill with low hemoglobin concentrations to optimize oxygen utilization and delivery imbalance. Data suggest that RBC transfusion is also independently associated with significant morbidity. We seek to characterize RBC transfusion volumes among patients receiving extracorporeal membrane oxygenation (ECMO) support and test the hypothesis that red blood cell transfusion volume is an independent risk factor for mortality. ⋯ Greater red blood cell transfusion volumes among patients supported with ECMO for non-cardiac indications are independently associated with an increase in odds of mortality. A prospective investigation of restrictive RBC transfusion practices while receiving ECMO may be warranted in this population.
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Comparative Study
A pilot study comparing two polymethylpentene extracorporeal membrane oxygenators.
We compared two polymethylpentene oxygenators being used in our unit: the Maquet Quadrox-iD paediatric and the Medos Hilite 800LT. ⋯ According to our study, it seems to us that Medos Hilite 800LT membrane oxygenators demonstrate greater oxygen transfer and CO2 removal capacity than Maquet Quadrox-iD paediatric membrane oxygenators, at a similar cost. These results lead us to conclude that it is reasonable to continue using Medos Hilite 800LT membrane oxygenators. A broader comparison study would be necessary in order to support these initial results.
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Comparative Study
Evaluation of the new generation dual-lumen catheter for neonatal ECMO.
The purpose of this study was to compare the newly designed dual-lumen venovenous catheter (VR13, OriGen Biomedical, Austin, TX) with the current dual-lumen catheter (VV12, OriGen Biomedical). ⋯ These findings indicate that the VR13 catheter resulted in levels of recirculation equal to the VV12. Based on resistance measurements, we do not recommend the use of this new catheter beyond 400 ml/min until minor design changes are made.