Perfusion
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Comparative Study
In vitro comparison of two different methods of cell washing.
The storage of red blood cells (RBC) results in increased concentrations of plasma free hemoglobin, potassium, glucose, and lactate, among other undesirable substances. These concentrations continue to increase as RBC products age and can cause deleterious effects to the patient. In the setting of cardiac surgery, the autotransfusion devices are routinely used to wash blood that is shed from the surgical site. ⋯ When compared to the original untreated RBCs, the glucose, lactate, and potassium levels were decreased when washed in an autotranfusion device. Additionally, the free hemoglobin and LDH levels were significantly lower with the Medtronic Autolog cell saver than in the COBE 2991 Cell Processor. Washing the RBC donor units in an autotransfusion device prior to transfusion can effectively attenuate the increases seen in glucose, potassium, free hemoglobin, and LDH associated with RBC storage lesion.
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Jehovah's Witnesses present a challenge to cardiac surgeons, as quality of care is not only defined by mortality and morbidity, but also by the avoidance of blood transfusions. Over the last years, minimized perfusion circuits (MPC) have contributed substantially to the achievement of this goal in our clinic. Presented is a retrospective analysis of our experience. ⋯ These encouraging results emphasize the role MPCs can play in optimizing the quality of patient care. We hope that this report can serve as a stimulus for similar experiences.
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Dexmedetomidine (DMET) is a useful agent for sedation, both alone and in combination with other agents, in critically ill patients, including those on extracorporeal membrane oxygenation (ECMO) therapy. The drug is a clonidine-like derivative with an 8-fold greater specificity for the alpha 2-receptor while maintaining respiratory and cardiovascular stability. An in vitro ECMO circuit was used to study the effects of both "new" and "old" membrane oxygenators on the clearance of dexmedetomidine over the course of 24 hours. ⋯ Dexmedetomidine can be expected to exhibit concentration changes during ECMO therapy. This effect appears to be more related to adsorption to the polyvinyl chloride (PVC) tubing rather than the membrane oxygenator. Dosage adjustments during dexmedetomidine administration during ECMO therapy may be warranted in order to maintain adequate serum concentrations and, hence, the desired degree of sedation.*(Lack of equilibrium).
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Cardiac power output has been shown to quantify cardiac reserve. Cardiac reserve is defined as the difference between basal and maximal cardiac performance. We compared cardiac power index to other commonly used hemodynamic parameters to validate its usefulness to stage heart failure patients and determine the optimal time for implantation of mechanical circulatory support. A retrospective study of twenty-eight heart failure patients implanted with mechanical circulatory support was analyzed at three levels of drug therapy. Subjects were further separated into two categories: survived versus deceased. Cardiac power index was the only statistically significant hemodynamic parameter that identified cardiac reserve (p<0.05) in this patient population. These results showed that a cardiac power index at or below 0.34 Watts/m(2) resulted in increased mortality rate, ninety days post-implantation. ⋯ Cardiac reserve was a determinant of post-device survival; therefore, these data suggest that device implantation should occur prior to the 0.34 Watts/m(2) threshold.