Early pulmonary compliance increase during cardiac surgery predicted post-operative lung dysfunction

Perfusion ◽  
2017 ◽  
Vol 32 (8) ◽  
pp. 631-638 ◽  
Author(s):  
Yann Sacuto ◽  
Thierry Sacuto
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Lung Injury ◽  
Experimental Studies ◽  
Anesthetic Induction ◽  
Elective Cardiac Surgery ◽  
Surgical Closure ◽  
Pulmonary Compliance ◽  
Heart Operation ◽  
Lung Dysfunction

Introduction: Lung dysfunction following cardiac surgery is currently viewed as the consequence of atelectasis and lung injury. While the mechanism of atelectasis has been largely detailed, the pathogenesis of lung injury after cardiopulmonary bypass is still unclear. Based upon clinical and experimental studies, we hypothesized that lungs could be injured through a mechanical phenomenon. Methods: We recorded pulmonary compliance at six key moments of a heart operation in 62 adult patients undergoing elective cardiac surgery. We focused on the period lasting from anesthetic induction to aorta unclamping. We calculated the variation of static and dynamic pulmonary compliance caused by thorax opening; ΔCstat1 and ΔCdyn1 and that caused by cardiopulmonary bypass, ΔCstat2 and ΔCdyn2. Blood gases were performed under standardized ventilation after anesthetic induction and after surgical closure. The PaO2/FiO2 ratio was calculated. ∆PaO2/FiO2 was the criterion for lung dysfunction. We compared ΔCstat1 and ΔCdyn1 with both ∆PaO2/FiO2 and, respectively, ΔCstat2 and ΔCdyn2. Results: Static and dynamic compliance increased with the opening of the thorax and decreased with the start of cardiopulmonary bypass. The PaO2/FiO2 ratio diminished after surgery. ΔCstat1 and ΔCdyn1 were negatively correlated with both ∆PaO2/FiO2 (r=-0.42; p<0.001 and r=-0.44; p<0.001) and, respectively, with ΔCstat2 and ΔCdyn2 (r=-0.59; p<0.001 and r=-0.53; p<0.001). Conclusions: Increased pulmonary compliance induced by the opening of the thorax is correlated with worsened intrapulmonary shunt after cardiopulmonary bypass. A mechanical phenomenon could be partly responsible for post-operative hypoxemia.

Abstract 1667: Early Childhood Mental Development After Transfusion-free Cardiac Surgery On Cardiopulmonary Bypass: A Multi-institutional Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tomohiko Ukai ◽  
Takenori Adachi ◽  
Atsusi Numaguchi ◽  
Daichi Fukumi ◽  
Toshiaki Yasuda ◽  
...  
Keyword(s):  
Early Childhood ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Brain Dysfunction ◽  
Hemoglobin Level ◽  
Mental Development ◽  
Blood Products ◽  
Surgical Closure ◽  
Group A ◽  
Group B

Background: The use of blood products is often necessary to prime the extracorporeal circuits for pediatric cardiac surgical patients. The use of blood products carries serious risks both in the acute and long-term aspects of patient care. However, excessive hemodilution during cardiopulmonary bypass (CPB) is associated with decreased oxygen carrying capacity, edema, and organ dysfunction. Especially, whether brain dysfunction after transfusion-free cardiac surgery on CPB occurred is unknown. Objective: This study aims to investigate whether excessive hemodilution affects child’s mental development. Methods: We studied 143 infants (24.2 +/− 15.8 months, 5 months ~ 3 years of age) had performed surgical closure of ventricular septal defect (VSD) in less than 12 months (4.8 +/− 2.6 months) of age in 7 children’s hospitals. Questionnaires mailed to the parents included the Tsumori-Inage Infant Developmental Scale estimating subjects’ behavioral developmental level as Developmental Quotients (DQ). The infants were divided into 3 groups; transfusion-free (Group A, n=52), transfusion during CPB (Group B, n=24) and transfusion after CPB (Group C, n=66). Results: Lower DQ was found for Group A (94.7 +/− 11.6) than Group B (103.5 +/− 16.0, p=0.008) and Group C (101.7 +/− 17.9, p=0.016). No correlation was found between DQ and minimum hemoglobin level during CPB (min-Hb) in Group A. The DQ was likely to be lower in the infants with below 6 g/dl (93.0 +/− 13.0) than with over 6 g/dl (98.7 +/− 8.3. p=0.10) of min-Hb. Conclusions: The results suggest that the infants after transfusion-free surgery of VSD on CPB delay in the mental development in their early childhood. Maintaining minimum hemoglobin level over 6 g/dl during CPB seems to prevent the mental development from delay.

Low dose aprotinin and low dose tranexamic acid in elective cardiac surgery with cardiopulmonary bypass

2009 ◽  
Vol 42 (4) ◽  
pp. 269-277 ◽  
Author(s):  
Thomas Waldow ◽  
Diana Krutzsch ◽  
Michael Wils ◽  
Katrin Plötze ◽  
Klaus Matschke
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Tranexamic Acid ◽  
Low Dose ◽  
Elective Cardiac Surgery

Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 313-320 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Annalisa Franco ◽  
Chiara Gerli ◽  
Monica De Luca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Troponin T ◽  
Mechanical Activity ◽  
Double Blind ◽  
Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study

Perfusion ◽  
2019 ◽  
Vol 35 (2) ◽  
pp. 138-144
Author(s):  
Helena Argiriadou ◽  
Polychronis Antonitsis ◽  
Anna Gkiouliava ◽  
Evangelia Papapostolou ◽  
Apostolos Deliopoulos ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Correlation Coefficient ◽  
Platelet Function ◽  
Extracorporeal Circulation ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Minimal Invasive ◽  
Elective Cardiac Surgery ◽  
Impedance Aggregometry

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.

scholarly journals P644Mechanisms of myocardial nitroso redox imbalance following elective cardiac surgery on cardiopulmonary bypass

2014 ◽  
Vol 103 (suppl 1) ◽  
pp. S117.2-S117
Author(s):  
R Jayaram ◽  
N Goodfellow ◽  
K Nahar ◽  
MH Zhang ◽  
S Reilly ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Elective Cardiac Surgery ◽  
Redox Imbalance

scholarly journals RENAL FUNCTION CHANGES AFTER ELECTIVE CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

Renal Failure ◽  
2000 ◽  
Vol 22 (4) ◽  
pp. 487-497 ◽  
Author(s):  
Erinéia Maria de Moraes Lobo ◽  
Emmanuel A. Burdmann ◽  
Regina C. R. M. Abdulkader
Keyword(s):  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Elective Cardiac Surgery

Automatic regulation of the cardiopulmonary bypass

Perfusion ◽  
1986 ◽  
Vol 1 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Juro Wada ◽  
Tsunekazu Hino ◽  
Hideki Kaizuka ◽  
Wolfgang R Ade
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Central Venous Pressure ◽  
Venous Return ◽  
Venous Pressure ◽  
Experimental Studies ◽  
Automatic Regulation ◽  
Central Venous ◽  
Respiratory Change ◽  
Clinical Cases

We devised a new method and system for the automatic regulation of cardiopulmonary bypass. The system is planned so that it is regulated according to the alteration of venous pressure which is a reflection of venous return in total cardiopulmonary bypass. After many experimental studies, we have used this system in four clinical cases of cardiac surgery. The system functioned sufficiently well in the clinical cases. Under the control of this system, the central venous pressure was kept at a preset level and changed cyclically in the same manner as the respiratory change through the entire cardiopulmonary bypass period. A constant and adequate venous return through the entire cardiopulmonary bypass period was assumed to be the most important factor for the venous return-triggered pump oxygenator.

Propofol requirement titrated to bispectral index: a comparison between hypothermic and normothermic cardiopulmonary bypass

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 27-32 ◽  
Author(s):  
PJ Mathew ◽  
GD Puri ◽  
RS Dhaliwal
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Adult Patients ◽  
Study Group ◽  
Factors Affecting ◽  
Inter Quartile Range ◽  
Elective Cardiac Surgery ◽  
Quartile Range ◽  
Hypothermic Group

Though propofol requirement is expected to decrease during cardiopulmonary bypass (CPB), a few studies have failed to demonstrate this. The factors affecting pharmacokinetics of propofol and, therefore, the requirement, are different during hypothermic and normothermic CPB. We evaluated and compared the requirement of propofol during hypothermic and normothermic CPB. Fifty adult patients scheduled for elective cardiac surgery on CPB were recruited and randomly allocated into hypothermic CPB (28–300 C) (Group H) and normothermic CPB (35–370 C) (Group N) groups. Patients were induced and maintained with propofol titrated to maintain a target bispectral index (BIS) of 50 ± 10. Propofol requirement (mean ± SD) was similar in normothermic and hypothermic groups, both before CPB (4.9 ± 1.5 mg.kg−1hr−1 in Group N, 4.6 ± 1.5 mg.kg−1hr−1 in Group H) and after cessation of bypass (p > 0.05) (4.6 ± 1.8 mg.kg−1hr−1 in Group N and 4.3 ± 1.7 mg.kg−1hr−1 in Group H). CPB significantly reduced (p < 0.001) propofol requirements in both arms of the study (Group N: 2.9 ± 1.4 mg.kg−1hr−1and Group H: 1.3 ± 0.7 mg.kg−1hr−1). This reduction was more pronounced in the hypothermic group (p < 0.001). The BIS (median ± inter quartile range) remained constant during normothermic CPB (50 ± 8.8), but declined significantly during hypothermic CPB (41 ± 5.6) despite decreased usage of propofol during hypothermia. No patient had recall of intra-operative events. CPB decreases the magnitude of propofol requirements and the effect of hypothermic CPB is significantly more than that of normothermic CPB.

scholarly journals Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery

2017 ◽  
Vol 24 (3) ◽  
pp. 153-158
Author(s):  
Gabrielius Jakutis ◽  
Ieva Norkienė ◽  
Donata Ringaitienė ◽  
Tomas Jovaiša
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Hospital Stay ◽  
Prolonged Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Research Database ◽  
Elective Cardiac Surgery ◽  
The Impact

Background. Hyperoxia has long been perceived as a desirable or at least an inevitable part of cardiopulmonary bypass. Recent evidence suggest that it might have multiple detrimental effects on patient homeostasis. The aim of the study was to identify the determinants of supra-physiological values of partial oxygen pressure during on-pump cardiac surgery and to assess the impact of hyperoxia on clinical outcomes. Materials and methods. Retrospective data analysis of the institutional research database was performed to evaluate the effects of hyperoxia in patients undergoing elective cardiac surgery with cardiopulmonary bypass, 246 patients were included in the final analysis. Patients were divided in three groups: mild hyperoxia (MHO, PaO2 100–199 mmHg), moderate hyperoxia (MdHO, PaO2 200–299 mmHg), and severe hyperoxia (SHO, PaO2 >300 mmHg). Postoperative complications and outcomes were defined according to standardised criteria of the Society of Thoracic Surgeons. Results. The extent of hyperoxia was more immense in patients with a lower body mass index (p = 0.001) and of female sex (p = 0.005). A significant link between severe hyperoxia and a higher incidence of infectious complications (p – 0.044), an increased length of hospital stay (p – 0.044) and extended duration of mechanical ventilation (p < 0.001) was confirmed. Conclusions. Severe hyperoxia is associated with an increased incidence of postoperative infectious complications, prolonged mechanical ventilation, and increased hospital stay.

Efficacy of a Simple Intraoperative Transfusion Algorithm for Nonerythrocyte Component Utilization after Cardiopulmonary Bypass

2001 ◽  
Vol 94 (5) ◽  
pp. 773-781 ◽  
Author(s):  
Gregory A. Nuttall ◽  
William C. Oliver ◽  
Paula J. Santrach ◽  
Sandra Bryant ◽  
Joseph A. Dearani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Loss ◽  
Operating Room ◽  
Prospective Trial ◽  
Median Number ◽  
Control Group ◽  
Coagulation Test ◽  
Elective Cardiac Surgery ◽  
Abnormal Bleeding

Background Abnormal bleeding after cardiopulmonary bypass (CPB) is a common complication of cardiac surgery, with important health and economic consequences. Coagulation test-based algorithms may reduce transfusion of non-erythrocyte allogeneic blood in patients with abnormal bleeding. Methods The authors performed a randomized prospective trial comparing allogeneic transfusion practices in 92 adult patients with abnormal bleeding after CPB. Patients with abnormal bleeding were randomized to one of two groups: a control group following individual anesthesiologist's transfusion practices and a protocol group using a transfusion algorithm guided by coagulation tests. Results Among 836 eligible patients having all types of elective cardiac surgery requiring CPB, 92 patients developed abnormal bleeding after CPB (incidence, 11%). The transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after CPB (median, 0 units; range, 0-7 units) than the control group (median, 3 units; range, 0-10 units) (P = 0.0002). The median number of platelet units transfused in the operating room after CPB was 4 (range, 0-12) in the algorithm group compared with 6 (range, 0-18) in the control group (P = 0.0001). Intensive care unit (ICU) mediastinal blood loss was significantly less in the algorithm group. Multivariate analysis demonstrated that transfusion algorithm use resulted in reduced ICU blood loss. The control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding (11.8% vs. 0%; P = 0.032). Conclusions Use of a coagulation test-based transfusion algorithm in cardiac surgery patients with abnormal bleeding after CPB reduced non-erythrocyte allogeneic transfusions in the operating room and ICU blood loss.

Sign in / Sign up

Export Citation Format

Share Document