ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Randomized Controlled Trial
Effects of Sevoflurane Inhalation During Cardiopulmonary Bypass on Pediatric Patients: A Randomized Controlled Clinical Trial.
The effects of sevoflurane inhalation during cardiopulmonary bypass (CPB) on postoperative courses and serum cardiac troponin I (cTnI) concentrations in pediatric patients undergoing cardiac surgery have not been extensively investigated. In this single-center, prospective, randomized trial, an anesthetic regimen containing 2% sevoflurane used throughout the CPB process was compared with a total intravenous anesthesia (TIVA) regimen. One hundred and three patients undergoing congenital heart defect repair with CPB were included in this prospective randomized controlled study. ⋯ The postoperative ventilation time (in mean [95% confidence interval]) was shorter in the sevoflurane group than that in the control group (26.1 [19.2, 33.0] h vs. 37.7 [24.4, 50.9] h; p = 0.014). The postoperative ICU time, hospital days, and serial serum cTnI concentrations were not significantly different between the two groups. Inhalation of 2% sevoflurane during CPB is beneficial to the recovery of pediatric patients undergoing cardiac surgery but has no significant effect on postoperative cTnI release.
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Randomized Controlled Trial
Clinical validation of a real-time data processing system for cardiac output and arterial pressure measurement during intraoperative biventricular pacing optimization.
Biventricular pacing (BiVP) improves cardiac output (CO) and mean arterial pressure (MAP) after cardiopulmonary bypass (CPB) in selected patients at risk for acute left heart failure after cardiac surgery. Optimization of atrioventricular delay (AVD) and interventricular delay (VVD) to maximize the hemodynamic effect of pacing requires rapid and accurate data processing. Conventional post hoc data processing (PP) is accurate but time-consuming, and infeasible in the intraoperative setting. ⋯ Interexaminer reliability coefficient values ranged from 0.997 to 0.999, indicating RTP is as reliable as PP for optimization. Real-time data processing is instantaneous and therefore is more practical in a clinical setting than the PP method. Real-time data processing is useful for guiding intraoperative BiVP optimization and merits further development.
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Randomized Controlled Trial
Cardiac output measurement by arterial pressure waveform analysis during optimization of biventricular pacing after cardiac surgery.
Biventricular pacing (BiVP) can optimize cardiac output (CO) in patients after cardiac surgery, so devices that calculate continuous CO from arterial pressure may be a useful tool. We investigated PulseCO for measuring CO during optimization by comparison with aortic flow probe measurement. Seven patients in the Biventricular Pacing After Cardiac Surgery (BiPACS) trial were studied. ⋯ In contrast, changes in mean arterial pressure did not reflect changes in CO (intraclass correlation coefficient = 0.02). Thus, PulseCO can measure continuous CO in open-chest patients after cardiac surgery, whereas underestimating changes occurring across 10-second pacemaker changes. Further studies in the closed chest are indicated.
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Randomized Controlled Trial
Clinical application of pulsatile perfusion during cardiopulmonary bypass in pediatric heart surgery.
The benefits of pulsatile over nonpulsatile perfusion has been widely debated in pediatric cardiac operations with cardiopulmonary bypass (CPB). To evaluate the role of pulsatile perfusion in pediatric complicated patients with congenital heart disease undergoing open heart surgery, we performed pulsatile CPB and compared several effects with nonpulsatile perfusion. Pediatric patients (n = 24) diagnosed as typical tetralogy of Fallot (TOF) were randomly divided into two groups: pulsatile perfusion (PP) group and nonpulsatile perfusion (NP) group. ⋯ Free plasma hemoglobin concentration in PP group at preclamp off and CPB weaned off were higher than that of NP group (p < 0.05). Pulsatile perfusion can be successfully applied in pediatric perfusion. Pulsatile perfusion had the role of reducing concentration of inflammatory media in pediatric patients.
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Randomized Controlled Trial
Effect of different albumin concentrations in extracorporeal circuit prime on perioperative fluid status in young children.
This study examined the effects of different dosages of albumin priming for extracorporeal circuit (ECC) on perioperative fluid status and fluid management in young children. A total of 151 consecutive pediatric patients (2-36 months old) scheduled for open heart surgery, were divided into two groups randomly, to receive either a 3% albumin solution (L group, n = 68) or a 5% albumin (H group, n = 83). Perioperative fluid intake, urine output, blood loss, diuretic dosage, the use of allogeneic blood products, ultrafiltration, and daily balance were recorded for 24 hrs in intensive care unit (ICU). ⋯ No statistically significant differences were found between the two groups in blood loss and the amount of allogenic blood products infused, length of mechanical ventilation, ICU or hospital stay, complications, or mortality. Higher concentration of albumin prime in ECC showed decreased positive fluid balances, but produced less urine output and required more diuretic usage postoperatively. Thus, no significant clinical benefit resulted from the increased dosage.