Perfusion
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Filtration of cardiopulmonary bypass (CPB) priming fluid before connection of the circuit to the patient was first accomplished by arterial line filtration. When dedicated prebypass filters (PBFs) with smaller pore sizes became available, a large number of particles could be found on the filter surface. In recent years, modern manufacturing methods for CPB circuit components were believed to be associated with a reduced number of particles found in components of extracorporeal circuits, making separate filtration of CPB priming solution unnecessary. ⋯ Filtration of crystalloid CPB priming solutions with a PBF consisting of a filter membrane with a pore size of 0.2 microm was found to effectively reduce the number of microemboli. Infusion filters with a filter pore size of 0.2 microm were found to reduce the endotoxin contamination in infusion solutions. Prebypass filtration with filters containing pores of 0.2 pm should be a necessity for contemporary perfusion practice.
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Randomized Controlled Trial Clinical Trial
Strategic leukocyte depletion reduces pulmonary microvascular pressure and improves pulmonary status post-cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) precipitates inflammation that causes marked pulmonary dysfunction. Leukocyte filtration has been proposed to reduce these deleterious effects. Other studies show an improvement with aprotinin. ⋯ Increasing PMVPs are a direct reflection of pulmonary capillary edema, which, in conjunction with increased pulmonary shunt ratio, lead to an overall worsening of pulmonary function. Intraoperative strategic leukocyte filtration combined with aprotinin treatment improves post-CPB lung performance by reducing significantly the reperfusion inflammatory response and its sequelae. These benefits are manifested by reductions in ventilator times, hospital stay and patient morbidity.
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Randomized Controlled Trial Clinical Trial
The effect of zero-balanced ultrafiltration during cardiopulmonary bypass on S100b release and cognitive function.
Zero-balanced ultrafiltration (ZBUF) might reduce the systemic inflammatory response (SIRS) during cardiopulmonary bypass (CPB) by removing inflammatory mediators. The objective of this study was to determine the effect of ZBUF on postoperative serum S100b levels, a marker of neuronal injury. In addition, the possible effects of ZBUF on postoperative neurocognitive function were assessed. ⋯ This result is not affected by washout. ZBUF did not reduce the incidence of early neurocognitive deficits. The role of SIRS in the development of cognitive dysfunction following CPB remains to be resolved.
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Comparative Study
Modified ultrafiltration in surgical correction of congenital heart disease with cardiopulmonary bypass.
The surgical correction of congenital heart disease using haemodilution and hypothermia with cardiopulmonary bypass (CPB) may expose patients to tissue ischaemia and initiate a systemic inflammatory response, increasing the total body water and inducing impairment, especially of heart, lung and brain function. It is possible to use ultrafiltration during CPB in the rewarming phase to remove water accumulation in the third space (conventional ultrafiltration). The reduced volume of prime used in children and the ability only to filter the reservoir blood during CPB led the Great Ormond Street Group to modify the method of ultrafiltration with regards to the placement of the filter and the timing of filtration (post-CPB). ⋯ From January 1996 to March 1998, 41 patients underwent correction of congenital heart disease and were submitted to a comparative study (homogeneous groups), using either the conventional or the conventional + modified ultrafiltration techniques. There were no technical complications, no patient required mediastinal re-exploration due to bleeding and it was possible to close all the chests. There were significant differences in the ultrafiltrate volume balance (143.3 +/- 54.3 versus 227 +/- 71.4 mL; P < 0.001) but there were no significant differences in clinical postoperative evolution between the conventional and the conventional + modified ultrafiltration.
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Comparative Study
Improved oxygenation with reduced recirculation during venovenous ECMO: comparison of two catheters.
To determine whether the new double-lumen catheter made by OriGen Biomedical (Austin, TX) for venovenous (VV) extracorporeal membrane oxygenation (ECMO) would reduce recirculation and improve oxygenation during VV ECMO when compared with the Kendall double-lumen catheter (Kendall Healthcare Products, Mansfield, MA). ⋯ These findings indicate that the OriGen catheter resulted in a reduction of recirculation, thereby resulting in an improvement in oxygenation while on VV ECMO. The lower postmembrane pressure potentially could reduce the risk of ECMO circuit complications such as tubing rupture, bleeding complications, as well as hemolysis. This new catheter makes VV ECMO more effective and represents a design that could be used for neonatal and/or pediatric ECMO.