Adjusting Oxygen Fraction to Avoid Hyperoxemia during Cardiopulmonary Bypass

2007 ◽  
Vol 15 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Serdar Evrenkaya ◽  
Sahin Senay ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Oxygen Fraction ◽  
Wide Range ◽  
Group 3 ◽  
Group 2 ◽  
Inspired Oxygen ◽  
Group 1

Although an adverse influence of hyperoxemia during cardiopulmonary bypass is well documented, there is a wide range of oxygen settings during cardiopulmonary bypass, based mostly on trial and error. The aim of this study was to determine the optimal inspired oxygen fraction during cardiopulmonary bypass. Ninety patients undergoing isolated coronary artery bypass operations were randomly allocated to one of 3 groups of 30 each. In group 1, cardiopulmonary bypass was started with an inspired oxygen fraction of 0.40, increased to 0.60 during rewarming. These settings were 0.40 and 0.50 in group 2, and 0.35 and 0.45 in group 3. Samples for blood gas analysis were collected at defined time periods during the operation. PaO2 was significantly higher in groups 1 and 2 compared to group 3. All patients in group 1 and 88% of patients in group 2 suffered at least one episode of hyperoxemia during cardiopulmonary bypass, compared to 30% of patients in group 3. The differences were significant, and we concluded that to avoid hyperoxemia, inspired oxygen fraction should be kept at 0.35 during cardiopulmonary bypass and increased to 0.45 during rewarming.

Adjustment of sweep gas flow during cardiopulmonary bypass

Perfusion ◽  
2002 ◽  
Vol 17 (5) ◽  
pp. 353-356 ◽  
Author(s):  
Hasan Karabulut ◽  
Fevzi Toraman ◽  
Sümer Tarcan ◽  
Önder Demirhisa ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Gas Flow ◽  
Surgical Techniques ◽  
Blood Gas Analysis ◽  
Carbon Dioxide Production ◽  
Gas Analysis ◽  
Lung Mechanics ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Cardiopulmonary bypass (CPB) is one of the major tools of cardiac surgery. However, no clear data are available for the ideal value of sweep gas flow to oxygenator during CPB. The aim of this study was to determine the best value for sweep gas flow during CPB. Thirty patients undergoing isolated CABG were randomly and equally allocated into three groups. Sweep gas flow to oxygenator was kept at 1.35 l/min/m2 in group 1, 1.60 l/min/m2 in group 2, and 2.0 l/min/m2 in group 3. All patients were operated on under the same anaesthetic regime and surgical techniques. Samples for blood gas analysis were collected at T1: before CPB; T2: 5 min after the initiation of CPB; T3: just before rewarming; and T4: at the end of rewarming. Five minutes after the initiation of CPB (T2), pCO2 decreased significantly in groups 2 and 3 compared to group 1 ( p < 0.02). With the addition of hypothermia (T3), the changes in the pH and pCO2 became more profound and, in this period, the levels in group 3 patients outranged the physiologic limits, with pCO2 and pH values being 28± 3 mmHg and 7.50± 0.04, respectively. At the end of the rewarming period (T4), in spite of increased carbon dioxide production, pCO2 values were below the physiologic limits in groups 2 and 3. We conclude that sweep gas flow to the oxygenator should be kept between 1.35 and 1.60 l/min/m2 during CPB to avoid hypocapnia, which results in alkalosis and has hazardous effects on lung mechanics, cerebral blood flow, and the cardiovascular system.

Comparison of Antihypertensives after Coronary Artery Surgery

2005 ◽  
Vol 13 (4) ◽  
pp. 302-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Hasan Karabulut ◽  
Onur Goksel ◽  
Serdar Evrenkaya ◽  
Sumer Tarcan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sodium Nitroprusside ◽  
Artery Bypass ◽  
Effective Control ◽  
Hemodynamic Effects ◽  
Double Product ◽  
Myocardial Infraction ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg·kg−1 within 5 min, followed by infusion of 0.1–0.8 mg·kg−1·h−1 in group 1. Nitroglycerin was infused at a rate of 1–3 μg·kg·h−1 in group 2, and sodium nitroprusside was given at a rate of 1–3 μg·kg−1·min−1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p < 0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.

Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Edmundas Sirvinskas ◽  
Audrone Veikutiene ◽  
Pranas Grybauskas ◽  
Jurate Cimbolaityte ◽  
Ausra Mongirdiene ◽  
...  
Keyword(s):  
Platelet Count ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Blood Loss ◽  
Platelet Function ◽  
Artery Bypass ◽  
Postoperative Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p <0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p <0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p <0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p <0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p <0.05), 27.3% of patients in Group 2 ( p <0.05) and in 35.7% of patients in Group 3 ( p <0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p <0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

scholarly journals Features and hospital outcomes of coronary artery bypass grafting in patients with calcification of target coronary arteries

2020 ◽  
Vol 25 (8) ◽  
pp. 3687
Author(s):  
R. S. Akchurin ◽  
A. A. Shiryaev ◽  
V. P. Vasiliev ◽  
D. M. Galyautdinov ◽  
E. E. Vlasova ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Early Results ◽  
Group 2 ◽  
Group 1

Aim. To compare strategy and early results of coronary artery bypass grafting (CABG) in patients with and without calcification of target coronary arteries (TCA).Material and methods. The prospective study analyzed the data of patients (n=462) who underwent elective isolated CABG in 2017-2018 using cardiopulmonary bypass and microsurgery. Two groups were distinguished: group 1 — patients with TCA calcification (n=108), group 2 — patients without TCA calcification (n=354). In cases where the distal coronary artery lesion did not allow standard bypass grafting, additional complex anastomoses were provided. A comparison of intraoperative parameters and early results of CABG was carried out.Results. In groups 1 and 2, the revascularization index did not differ significantly and was 4,5 and 4,3, respectively. The frequency of complex surgical interventions in group 1 was higher: for example, ‘Y’ grafts were used in groups 1 and 2, respectively, in 32% (35/108) and 12% (44/354), p<0,05; sequential anastomoses in 14% (15/108) and 7% (26/354), p<0,05; prolonged patch-angioplasty — in 21% (23/108) and 5% (16/354), p<0,05; anastomoses with arteries <1,5 mm in diameter — in 33% (36/108) and 4% (14/354), p<0,05; coronary endarterectomy in 17% (18/108) and 5% (16/354), p<0,05, respectively. The duration of cardiopulmonary bypass was longer in group 1. At the same time, the hospital clinical results did not differ significantly: mortality was not registered; the frequency of perioperative myocardial infarction was 1,8% (group 1) and 1,1% (group 2); the need for inotropes, frequency of arrhythmia, length of stay in the intensive care unit and hospital were similar; there were no cases of in-hospital angina recurrence.Conclusion. CABG in patients with calcification of TCA is associated with surgical challenges and need for complex adjunct techniques. Nevertheless, complete surgical revascularization is real in these cases, and the hospital results are comparable to those in patients without calcification.

Cardiac Tamponade After Removal of Temporary Pacer Wires

2012 ◽  
Vol 21 (6) ◽  
pp. 432-440 ◽  
Author(s):  
Linda Mahon ◽  
James F. Bena ◽  
Shannon M. Morrison ◽  
Nancy M. Albert
Keyword(s):  
Cardiac Tamponade ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Vital Signs ◽  
Smoking History ◽  
Initial Surgery ◽  
Temporary Pacemaker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. Objectives To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Methods Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Results Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Conclusions Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

Diagnostic performance of sensitive measurements of serum thyrotropin during severe nonthyroidal illness: their role in the diagnosis of hyperthyroidism.

1987 ◽  
Vol 33 (12) ◽  
pp. 2178-2184 ◽  
Author(s):  
M F Bayer ◽  
J A Macoviak ◽  
I R McDougall
Keyword(s):  
Thyroid Disease ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Transplant Recipients ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Serial Measurements ◽  
Group 1

Abstract Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.

Intravenous Diltiazem for Treatment of Supraventricular Tachycardia after Coronary Artery Bypass Surgery

1998 ◽  
Vol 6 (3) ◽  
pp. 203-207
Author(s):  
C Levent Birincioğlu ◽  
A Tulga Ulus ◽  
Birol Yamak ◽  
S Fehmi Katircioğlu ◽  
Binali Mavitaş ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Supraventricular Tachycardia ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Between 1995 and 1997, 180 patients who had undergone coronary artery bypass grafting were given intravenous diltiazem for conversion of supraventricular tachycardia to sinus rhythm or control of ventricular rhythm in atrial fibrillation. The patients were divided into three groups of 60 each: group 1 required no inotropic support; group 2 had mild inotropic support with dopamine; group 3 had high-dose inotropic support with adrenalin and dopamine. Thirty-eight patients in group 1 (63%), 40 in group 2 (67%), and 32 in group 3 (53%) responded to one or two doses of diltiazem. There was no difference between the groups in terms of the success rate of the treatment (p > 0.05). Additional procedures were needed in 70 patients including cardioversion in 20 (12 in group 1, 8 in group 2). Mean cardiac index was significantly increased and mean pulmonary artery pressure was significantly decreased in all three groups after diltiazem treatment. After the first dose of diltiazem (0.25 mg·kg−1), the mean heart rate decreased from 141.5mg·kg−1 ± 3.8, 136.9 ± 8.5, and 140.2 ± 4.7 to 118.2 ± 5.1, 101.2 ± 6.7, and 105.6 ± 16.8 in groups 1, 2, and 3, respectively. The maximum decrease was seen after 5 minutes. After the second dose of diltiazem (0.35 mg·kg−1), although mean heart rates were not significantly decreased, 45% of group 1, 44% of group 2, and 46% of group 3 patients who did not respond to the first dose of diltiazem, converted to sinus rhythm. In the early postoperative period after coronary artery bypass graft surgery, diltiazem was of benefit in the treatment of supraventricular tachycardia and atrial fibrillation or flutter. This treatment may be especially useful in patients who are in poor hemodynamic condition.

scholarly journals Evaluation of circulating endothelial cells in the rat after acute and fractionated whole-body gamma irradiation

Nukleonika ◽  
2014 ◽  
Vol 59 (4) ◽  
pp. 145-151 ◽  
Author(s):  
Ghassan Al-Massarani ◽  
Khaled Almohamad
Keyword(s):  
Endothelial Cells ◽  
Gamma Irradiation ◽  
Circulating Endothelial Cells ◽  
Whole Body ◽  
Dependent Manner ◽  
Wide Range ◽  
Group 3 ◽  
Group 2 ◽  
Dose Dependent ◽  
Group 1

Abstract Purpose: Damage to vascular endothelial cells is a well recognised complication of the irradiation. Our objective was to determine the gamma-irradiation effect on the rat circulating endothelial cells (CEC). Material and methods: Eight-week old rats were divided into four groups: group 1 - rats were exposed to acute whole- -body gamma irradiation with a wide range of single doses (0.5, 1, 2, 4 and 8 Gy), group 2 - rats were exposed to fractionated low doses of irradiation (0.1, 0.5 and 1 Gy) every three days for two months, group 3 as group 2, but followed by two months of rest, group 4 were control animals. CEC (CD146 positive cells) in group 1 were counted following CD146-based immuno-magnetic separation after one day and one week, as well as at the end of experiment in the other groups. Results: Quantified CEC showed that there was a dose-dependent reduction in CEC count in group 1 (one week after irradiation) and group 2. A partial re-population of CEC was observed at the end of experiment in both group 1 and group 2 compared to control group. Group 3 showed a significant increase in CEC levels as compared with group 2 without reaching the control level. Conclusion: The number of CEC (CD146 positive cells) in rats exposed to whole-body gamma irradiation was reduced in a dose-dependent manner and it partly recovered during the two-month interval after irradiation. We suggest that CEC count may be an indicator of the radiation-induced vascular damage.

Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

2020 ◽  
pp. 021849232096643
Author(s):  
Serdar Gunaydin ◽  
Orhan Eren Gunertem ◽  
Seyhan Babaroglu ◽  
Atike Tekeli Kunt ◽  
Kevin McCusker ◽  
...  
Keyword(s):  
Single Dose ◽  
Coronary Artery ◽  
High Risk ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Risk Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. Methods This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( n = 101) had a single dose of del Nido cardioplegia, group 2 ( n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. Results Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. Conclusions Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.

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