Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Dec 1992
Randomized Controlled Trial Clinical TrialSafety of a guidewire technique for replacement of pulmonary artery catheters.
The purpose of this study was to determine if a guidewire change from a pulmonary artery catheter (PAC) to a central venous catheter (CVC) poses a significant infection risk. A total of 128 consecutive cardiac surgical patients with PACs inserted in the operating room were entered into this study. Postoperatively, patients were randomly allocated to receive a double-lumen CVC, either at the initial introducer insertion site over a guidewire, or at a new site with de novo catheterization. ⋯ From 48 hours up to 72 hours following initial insertion of the PAC, an incidence of catheter-related infection of 35.3% was observed in the guidewire group, as opposed to 12.5% in the de novo group. It is recommended that the use of a guidewire technique for catheter replacement (PAC to CVC) is a safe alternative to de novo insertion of a CVC within 48 hours after initial insertion of the PAC. In order to minimize the potential risk of catheter-related infection and bacteremia in cardiac surgical patients, de novo catheterization beyond 48 hours after initial venapuncture is suggested.
-
J. Cardiothorac. Vasc. Anesth. · Dec 1992
ReviewCon: whole blood transfusions are not useful in patients undergoing cardiac surgery.
Data supporting fresh whole blood transfusion or fresh component therapy are nonblinded, and although both are conceptually attractive, neither can be considered proven. Recent blinded studies reflect fresh blood ineffectiveness. ⋯ Proven methods of blood conservation as well as standardized criteria for transfusion of blood components will more effectively decrease homologous blood transfusion. Transfusion of fresh or banked whole blood, or its components, has yet to be shown to decrease the usage of homologous blood products.
-
J. Cardiothorac. Vasc. Anesth. · Dec 1992
Changes in plasma atrial natriuretic peptide concentration during heart transplantation.
Examination of changes in plasma atrial natriuretic peptide (ANP) concentrations during heart transplantation may provide important information about factors influencing plasma ANP in patients with severe heart failure. Serial changes in plasma ANP during heart transplantation, and atrial content of ANP in native and donor atria, were measured in 12 patients. Preoperative plasma ANP was elevated in all patients (387 +/- 77 pg/mL), whereas atrial content of ANP in native atria was reduced (0.36 +/- 0.082 micrograms/mg protein). ⋯ Postoperative plasma ANP was not correlated with hemodynamics, but was negatively correlated with both creatinine clearance (r = -0.65, P < .05) and content of ANP in the native atria (r = -0.75, P < .01). Multiple linear regression analysis suggested that up to 85% of the variability of early postoperative plasma ANP could be accounted for by the variability in these latter two parameters. The decrease in native atrial ANP content, in the context of elevated plasma ANP concentration, is consistent with prior animal studies suggesting that severe heart failure induces cellular adaptations favoring accelerated ANP synthesis and secretion (with resultant reduction in tissue content).(ABSTRACT TRUNCATED AT 250 WORDS)