ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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The experience of extracorporeal membrane oxygenation (ECMO) use for severe chickenpox pneumonia was reviewed. Case notes of all patients treated with ECMO for this disease between 1992 and 1997 were reviewed. Of 405 patients referred for ECMO during this period, the diagnosis was chickenpox pneumonia in 14 (3.5%); all 14 were treated with ECMO. ⋯ Deaths were caused by sepsis (5 patients, source identified in 4) and multiorgan failure (1 patient). Pneumonia as a complication of chickenpox can rapidly become severe and life threatening. Extracorporeal respiratory support may be helpful in patients refractory to conventional ventilation.
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Synthetic human alpha-atrial natriuretic peptide infusion in management after open heart operations.
Cardiopulmonary bypass (CPB) induces water retention in the third space, and the mechanism is partially associated with the activation of the renin-angiotensin-aldosterone system (RAAS). Atrial natriuretic peptide (ANP) has a gradual but strong diuretic effect and suppresses the RAAS activation. We examined the efficacy of synthetic human alpha-ANP (hANP) infusion in the management of the postoperative water balance control. ⋯ The total dosages of furosemide and potassium-chloride added during the first 72 postoperative hours were significantly smaller in group H. On the first postoperative day, plasma levels of renin activity and aldosterone were significantly lower in group H. These results suggest that postoperative hANP infusion, which provides a sufficient diuretic effect and suppresses CPB induced RAAS activation, may simplify management after open heart operations.
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Comparative Study Clinical Trial Controlled Clinical Trial
Plasma concentrations of midazolam in neonates receiving extracorporeal membrane oxygenation.
Drug disposition is affected during extracorporeal membrane oxygenation (ECMO). This study investigates the dose-concentration relationship of midazolam in neonates requiring ECMO during continuous infusion into the circuit (extracorporeally; n = 10) and intravenously (n = 10). Data on hourly doses and sedation scores were collected for 120 hours. ⋯ However, at 48 hours, observed concentrations exceeded those predicted, suggesting accumulation. We conclude that in the first 24 hours of ECMO, because of an expanded circulating volume and sequestration by the circuit, significantly more midazolam is required to achieve adequate sedation. Subsequently, and because of circuit saturation, maintenance doses should be reduced.
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We retrospectively searched for factors that can predict the circulating platelet count after cardiopulmonary bypass (CPB) and postoperative blood loss. Correlations between the circulating platelet count after CPB and several other perioperative variables were investigated in 42 patients who underwent cardiac surgery using the same type of oxygenator. Correlations between perioperative variables and 24 hour postoperative blood loss were also investigated. ⋯ Independent predictive factors for postoperative blood loss consisted of age and intraoperative blood loss (R2 = 0.231, p = 0.006). In addition to preoperative platelet count, age and amount of intraoperative blood transfusion are predictive factors for circulating platelet count after CPB. The association of postoperative blood loss with age and intraoperative blood loss may suggest friability of the tissues, including blood vessels, in elderly patients.
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Continuous renal replacement therapy (CRRT), such as continuous venovenous hemofiltration, has theoretical advantages over intermittent hemodialysis (IHD) that are related to cardiorespiratory stability, metabolic control, and fluid balance allowing nutritional supplementation. However, retrospective and controlled studies fail to show these advantages because of comorbidity associated with triage to CRRT. To compare outcomes using IHD versus CRRT, we applied published risk stratification models (Cleveland Clinic Foundation, Lohr index, and APACHE II) to the 349 patients with acute renal failure requiring renal replacement therapy at University of Michigan over the 2 year period including 1995 and 1996. ⋯ We conclude that the need for CRRT itself predicts mortality over and above that included in published risk models. Either CRRT is associated with some unidentified morbidity (e.g., treatment associated infection) or, more likely, triage to CRRT is associated with as yet unspecified comorbidity not detected in existing risk stratification schemes. It will be important to address these issues in any future studies evaluating outcome or comparing renal replacement therapy modalities among patients with severe acute renal failure.