Perfusion
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Comparative Study Clinical Trial
Comparison of hollow-fiber membrane oxygenators in terms of pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass in neonates.
The objective of this study was to investigate the effects of two hollow-fiber membrane oxygenators, the Capiox SX10 and the Lilliput 901, on pressure drop of the membranes during normothermic and hypothermic cardiopulmonary bypass (CPB) in neonates. ⋯ These results suggest that the Capiox SX10 hollow-fiber membrane oxygenator produced significantly lower membrane pressure drops and pre- and post-oxygenator ECC during normothermic and hypothermic CPB. Thus, blood trauma with the Capiox during extracorporeal circulation may be significantly lower compared to the Lilliput. Further studies, including the level of complements, platelets, neutrophils and cytokines, with these oxygenators are warranted.
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The respective value of procalcitonin (PCT) and C-reactive protein (CRP) as markers of postoperative complications after coronary bypass surgery is unclear. Therefore, complications during one week after surgery were studied to evaluate the predictive role of PCT and CRP changes during the immediate postoperative period. ⋯ A postoperative serum PCT concentration of >0.5 ng/mL is highly suggestive of a postoperative complication. CRP changes do not contribute to predictive information.
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Comparative Study
Performance of polymethyl pentene oxygenators for neonatal extracorporeal membrane oxygenation: a comparison with silicone membrane oxygenators.
To review the performance of polymethyl pentene versus silicone oxygenators in terms of efficiency in priming and oxygenation, oxygenator resistance, requirements for coagulation proteins and consumption of blood products, for neonatal extracorporeal membrane oxygenation (ECMO) patients. ⋯ Small PMP oxygenators (Medos Hilite 800 LT) provide adequate gas exchange and offer technical advantages in terms of more efficient priming, reduced haemodynamic resistance and better control and preservation of coagulation proteins than silicone oxygenators.
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Rapid volume replacement for severe hemorrhage continues to challenge the clinician involved in the care of the patient suffering hemorrhagic shock. We report on the development and utilization of two rapid-infuser systems for volume replacement in critically ill patients presenting in extremis. We have developed rapid-infusion circuits by using commercially available devices available at our institution. ⋯ There were no intraoperative deaths and the rapid-infuser was considered lifesaving in all instances. Mechanical rapid infusion systems may be lifesaving when severe hypovolemia or hemorrhagic shock is encountered. While both devices are able to meet the requirements of rapid fluid replacement, the MPS offers the most safety features and has become the standard of care at our institution.
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Randomized Controlled Trial Clinical Trial
Prospective study on cardiopulmonary bypass prime reduction and its effect on intraoperative blood product and hemoconcentrator use.
Evaluate the feasibility and clinical significance of crystalloid prime reduction during the initiation of cardiopulmonary bypass (CPB) using a modified bridge on the cardioplegia delivery system. ⋯ Using a modified cardioplegia delivery system is a safe and effective method of CPB prime reduction. A RPV resulted in fewer patients requiring PRBC transfusions and fewer hemoconcentrators used. Based on our experience, we would recommend attempting to reduce prime volume in all patients undergoing CPB.