ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Comparative Study
Clinical responses and improvement of some laboratory parameters following polymyxin B-immobilized fiber treatment in septic shock.
Direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo, Japan) was first developed in 1994 and has since been used for the treatment of septic shock. Positive clinical data, such as an increase in systolic blood pressure (SBP) and an improved Pao2/Fio2 ratio, have also been reported. We treated 27 septic shock patients using DHP-PMX. ⋯ The Pao2/Fio2 ratio increased significantly after DHP-PMX in the groups showing improved 2AG and PAI-1 levels (p = 0.0040). The SBP increased significantly in the group showing improved HMGB-1 levels (p < 0.0001). We observed a relationship between hemodynamic improvement and increase of the serum HMGB-1 levels and between improvement of respiratory functions and increase of the serum 2-AG and PAI-1 levels in septic shock patients treated with DHP-PMX.
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In this review, we summarize the history of tracheal reconstruction and replacement as well as progress in current tracheal substitutes. In Part 1, we cover the historical highlights of grafts, flaps, tube construction, and tissue transplants and address the progress made in tracheal stenting as a means of temporary tracheal support. ⋯ We conclude Part 2 with a summary of recent efforts toward generating a bioengineered trachea. Finally, we provide an algorithm on the spectrum of options available for tracheal replacement.
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We compared the morbidity of patients with meconium aspiration syndrome (MAS) with that in patients with all other respiratory conditions treated with extracorporeal membrane oxygenation (ECMO) (no MAS). If ECMO for MAS was associated with a lower complication rate, then relaxed ECMO entry criteria could be considered. A retrospective review was performed of all patients in the national extracorporeal life support (ELSO) registry from 1989 to 2004. ⋯ Overall, MAS patients had a significantly lower number of complications per patient in each category versus no-MAS patients. These results indicate that regardless of type of ECMO, there are fewer complications on ECMO in MAS versus no-MAS patients. These data support the consideration of relaxed ECMO entry criteria for MAS.
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Anticoagulation for extracorporeal life support (ECLS) is routinely achieved using heparin, which can be difficult in patients suspected of having heparin-induced thrombocytopenia. We describe a case series of five patients in which we used argatroban, a direct thrombin inhibitor, as an alternative to heparin for systemic anticoagulation during ECLS in patients suspected to have heparin-induced thrombocytopenia. Argatroban was used to achieve target systemic anticoagulation for activate clotting times between 210 and 230. ⋯ Argatroban dosage ranged from 0.2 to 3.5 microg/kg/min. Activated clotting times showed good agreement with aPTT. In conclusion, we illustrate that argatroban is a reasonable alternative to heparin anticoagulation for patients requiring ECLS.
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Case Reports
From Baghdad to Germany: use of a new pumpless extracorporeal lung assist system in two severely injured US soldiers.
The authors describe a new extracorporeal pumpless interventional lung assist system (iLA) that was implemented in two US soldiers with severe acute respiratory distress syndrome received from enemy action in Iraq, who were at risk for critical hypoxemia/hypercapnia. The system is characterized by a new low-resistance gas exchange membrane that is integrated in an arterial-venous bypass established by cannulation of the femoral artery and vein. Cardiovascular stability is essential to produce sufficiently high blood flow rates over the gas exchange unit. ⋯ The iLA was removed after 15 and 8 days of continuous operation, respectively, and both soldiers were successfully weaned from mechanical ventilation. Interventional, extracorporeal pump-free pulmonary support opens up new possibilities for pulmonary protection due to ease of use, effectiveness, and low costs; however, there is concern of distal limb ischemia. Experiences to date are encouraging, although randomized studies are lacking, and the procedure carries significant risks.