ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Randomized Controlled Trial
Reducing the effects of the systemic inflammatory response to cardiopulmonary bypass: can single dose steroids blunt systemic inflammatory response syndrome?
The use of cardiopulmonary bypass (CPB) is associated with the development of a significant systemic inflammatory response syndrome (SIRS) which can affect patient outcomes. Multiple pathways are involved in initiating and maintaining SIRS. We studied whether a single dose of steroids (dexamethasone) after the induction of anesthesia could blunt the SIRS from CPB. ⋯ A single dose of dexamethasone reduces IL-6 and PNE levels associated with CPB. Despite the significant reductions in IL-6 and PNE, there was no effect on clinical outcomes. Additional studies are needed to demonstrate a clinically significant effect on patient outcomes.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lymphocyte's activation and apoptosis after coronary artery bypass graft: a comparative study of two membrane oxygenators--one with and another without a venous-arterial shunt.
Newer oxygenators with the latest technologies are designed to attenuate the immune response, including lymphopenia, prompted by cardiopulmonary bypass (CPB) in cardiac surgery. We evaluated the effect of CPB, comparing an oxygenator with a venous-arterial shunt and a conventional oxygenator with regard to lymphocyte's early activation and apoptosis induction and its implications in post-CPB lymphopenia. Patients undergoing coronary artery bypass graft surgery with CPB, using either a conventional oxygenator or one with a venous-arterial shunt, had blood samples drawn at anesthetic induction (baseline); the beginning and end of the CPB; and at 6, 12, and 24 hours after surgery. ⋯ Postoperative lymphopenia (50% decrease), 35% increased expression of CD69+, and 56% decrease in annexin V were significant comparing baseline to 24 hour value, similarly in both groups. Early activation (expression of CD69+) and degree of apoptosis (expression of annexin V) of lymphocytes after CBP in cardiac surgery was similarly observed in both types of oxygenators. The observed lymphopenia after CPB does not appear to be secondary to apoptosis.
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Randomized Controlled Trial Clinical Trial
PMEA coating of pump circuit and oxygenator may attenuate the early systemic inflammatory response in cardiopulmonary bypass surgery.
We investigated the effects of coating a cardiopulmonary bypass (CPB) circuit and oxygenator with poly-2-methoxy-ethyl acrylate (PMEA) on the systemic inflammatory response during and after CPB. Thirty patients undergoing elective cardiac surgery were randomized into three groups (each group n = 10): noncoated (group N), heparin coated (group H), and PMEA coated circuit and oxygenator (group X). Bradykinin (BK), complement 3 activation (C3a) and interleukin-6 (IL-6) levels were measured as early phase indicators of inflammatory response, as were maximum C reactive proteins (CRP) and white blood cell (WBC) levels. ⋯ A-a DO2 was lower at the end of and 3 hours after CPB in groups H and X than in group N (p < 0.05). Maximum CRP levels were lower in group X than in groups N (p < 0.05). This prospective study suggests that PMEA coated CPB may improve respiratory function and decrease systemic inflammatory response after cardiac surgery, possibly because this circuit is as biocompatible as heparin coated CPB circuit.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of three commercially available hollow fiber oxygenators: gas transfer performance and biocompatibility.
The new generation of oxygenators have improved blood flow pathways that enable reduction in priming volume and, thus, hemodilution during cardiopulmonary bypass (CPB). We evaluated three oxygenators and two sizes of venous reservoirs in relation to priming volume, gas transfer, and blood activation. To compare priming volume, gas transfer, and biocompatibility of three hollow fiber oxygenators and two different size venous reservoirs, 60 patients were randomly allocated in groups to undergo cardiopulmonary bypass. ⋯ The oxygenator with the largest blood contact surface area and improved geometric configuration (group 3) showed the lowest oxygen transfer rate per square meter. However, this oxygenator elevated oxygen partial pressure the most and reduced carbon dioxide partial pressure the most. In group 2, where a smaller venous reservoir was used, the highest blood activation was observed.
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Randomized Controlled Trial Clinical Trial
Clinical study of platelet function and coagulation/fibrinolysis with Duraflo II heparin coated cardiopulmonary bypass equipment.
This clinical study was performed to evaluate the effects of Duraflo II heparin coated cardiopulmonary bypass equipment on platelet and coagulation/fibrinolysis activation. Twenty-four patients undergoing coronary artery bypass grafting were assigned to two groups using either heparin coated (Duraflo group, n = 13) or uncoated equipment (control group, n = 11). In the Duraflo group, the cardiotomy reservoir was also coated with heparin. ⋯ Platelet loss and platelet activation, as measured by increases in plasma beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4), in the Duraflo group (beta-TG:237 +/- 143 ng/ml, PF4:167 +/- 104 ng/ml at the end of cardiopulmonary bypass) were less than those in the control group (beta-TG:373 +/- 131 ng/ml, PF4:295 +/- 131 ng/ml at the end of cardiopulmonary bypass). No significant differences were found in thrombin-antithrombin III complex levels or alpha 2 plasmin inhibitor-plasmin complex levels between the groups. Therefore, the use of Duraflo II heparin coated equipment with a heparin coated cardiotomy reservoir suppressed platelet activation.