ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Case Reports
Abdominal compartment syndrome in newborns and children supported on extracorporeal membrane oxygenation.
The objective of this study was to investigate the effect of timely peritoneal dialysis (PD) catheter in children with abdominal compartment syndrome (ACS) while supported on extracorporeal membrane oxygenation (ECMO). We present a case series of four patients who developed significant intraperitoneal fluid accumulation and ACS at the general pediatric and cardiac intensive care units in a tertiary children's hospital. The hospital's ECMO database was queried for patients supported on ECMO who required PD catheter placement. ⋯ One patient died of acute neurologic complication and the other because of severe gastrointestinal bleeding. After ruling out common causes for decreased venous return, ACS should be suspected as one of the important causes, especially in patients with massive capillary leak and increasing abdominal distension, among patients supported on ECMO. Timely placement of a PD catheter in patients who develop abdominal distension and ACS can substantially improve venous return and thus help maintain adequate tissue perfusion by improving ECMO flows.
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The purpose of this investigation was to use combined transcranial cerebral Doppler (TCD) and near-infrared spectroscopy cerebral oxygen saturation (NIRS) during total aortic arch replacement (TAAR) to monitor middle cerebral artery blood flow velocity and regional cerebral oximetry (rSO(2)) changes to provide a clinical basis for protective measures that may decrease injury of the central nervous system. Consecutive 12 adult patients underwent deep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP) during TAAR. A TCD probe was placed at the temporal windows after induction of anesthesia and the NIRS probe placed on the forehead of patients to collect perioperative, intraoperative, and postoperative hemodynamic parameters, and cerebral blood flow (CBF) and rSO(2) during cardiopulmonary bypass (CPB). ⋯ During DHCA when ASCP flow was lower than 5 ml/kg/min, TCD could not detect the MCA blood flow signal. When the flow of ASCP was above keeping around 10 ml/kg/min, MCA CBF velocity was maintained and rSO(2) > 45%. The combination of TCD and NIRS can be effective in monitoring brain function during DHCA with ASCP and may provide a guide for decreasing brain injury during the TAAR procedure.