ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Comparative Study
Validation of a new method to measure cardiac output during extracorporeal detoxification.
Cardiac output was measured in 11 patients during extra-corporeal detoxification after open heart surgery. All patients were mechanically ventilated and had pulmonary artery catheters for cardiac output (COT) measured by thermodilution. A sensor on the arterial side of the extracorporeal circulation measured flow and sound velocity transients. ⋯ The regression equation was COUD = 1.09 x COT-0.32 (r = 0.97, n = 31). These data suggest agreement between the ultrasound dilution technique and thermodilution. Ultrasound dilution is preferable in patients undergoing extracorporeal detoxification when pulmonary artery catheterization is not required or dangerous.
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Comparative Study
Hemodialysis access flow measurement. Comparison of ultrasound dilution and duplex ultrasonography.
Decreased hemodialysis access flow is associated with an increased risk of access thrombosis. Duplex ultrasonography can measure access flow and select a subset of patients at increased risk for access failure. With in-line techniques (ultrasound dilution), access flow can be measured during hemodialysis. ⋯ Regression analysis revealed a linear relationship between the two techniques described by the equation QAT = 246.14 + 0.8104(QAS) (correlation coefficient of 0.83; p < 0.0001). Measurement of hemodialysis access flow by ultrasound dilution was essentially equivalent to that obtained by duplex ultrasound. Additional studies are needed to determine if regular in-line flow measurements can predict and prevent future access thrombosis and decreased the cost of access management.
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Interleukin-6, interleukin-8, and polymorphonuclear leukocyte elastase levels in coronary sinus blood were measured and compared with those in arterial blood drawn from the radial artery before and immediately after cardiopulmonary bypass (CPB) during coronary artery bypass grafting in 20 patients. We introduced coronary sinus blood sampling as a useful method for evaluation of myocardial metabolism, myocardial protection, and reperfusion injury during CPB, especially by measurement of cytokines. ⋯ We conclude that the myocardium is not a predominant source of their release during CPB. Our results also showed that the measurement of these cytokines in systemic arterial blood reflected their levels in the whole body, including the myocardium, even during cardiac operation with CPB.
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Clinical Trial
Reduction of blood activation in patients receiving aprotinin during cardiopulmonary bypass for coronary artery surgery.
Aprotinin reduces blood loss after cardiac surgery, particularly in patients taking aspirin. This study was performed to evaluate whether the reduction of contact phase activation by aprotinin is related to decreased complement activation during blood activation. Two hundred patients were prospectively operated on for coronary artery bypass. ⋯ In addition, thrombin generation, as assessed by F1 + 2 scission peptide, was reduced by aprotinin (p = 0.01). However, the stepwise regression model emphasized that activation of the alternative and classic complement pathways, as reflected by C3b/c and C4b/c levels, was not affected by aprotinin; neither was leukocyte activation, as reflected by elastase release. These results suggest that aprotinin does not combine the reduction of complement activation with the reduced activation of the contact phase, fibrinolysis, or coagulation during CPB for coronary artery surgery.