Vancomycin concentrations during cardiopulmonary bypass in pediatric cardiac surgery: a prospective study

Perfusion ◽  
2021 ◽  
pp. 026765912110068
Author(s):  
Fiorenza Ferrari ◽  
Simona Benegni ◽  
Eleonora Marinari ◽  
Roberta Haiberger ◽  
Cristiana Garisto ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Prospective Study ◽  
Heart Surgery ◽  
Plasma Concentrations ◽  
Area Under The Curve ◽  
Skin Incision ◽  
Pediatric Cardiac Surgery ◽  
Few Data ◽  
A Prospective Study

Introduction: Few data are available regarding intraoperative plasma concentrations of vancomycin administered as prophylaxis in pediatric cardiac surgery. The aims of this study were to investigate during pediatric cardiac surgery with cardiopulmonary bypass(CPB) the attainment of the area-under-the-curve of the vancomycin serum concentrations versus time over surgery to minimum inhibitory concentration ratio(AUCintra/MIC) of 400 (mg × h)/l and/or a target concentration of 15–20 mg/l. Methods: In a prospective study, 40 patients divided into four subgroups (neonates, infants, children <10 years-old, ⩾10 years-old) undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. A slow vancomycin bolus of 20 mg/kg, up to a maximum dose of 1000 mg was administered before skin incision and a further dose of 10 mg/kg (up to 500 mg) at CPB start. Vancomycin samples were collected intraoperatively at four time points. Results: The median (interquartile range) age was 241.5 days (47–3898) and the median weight was 7.1 kg (3.1–37). The median AUCintra/MIC was 254.73 (165.89–508.06). In 11 patients the AUCintra/MIC target was not reached. Neonates displayed the lowest AUCintra/MIC values, and these were significantly lower than those of children ⩾10 years old (p = 0.02). Vancomycin concentrations were above the maximal target of 20 mg/l in 82.5% and 80% of patients at surgery and CPB start, respectively. At CPB and surgery end, 42.5% of patients showed vancomycin concentrations above 20 mg/l and 42.5% below 15 mg/l. Patients⩾10 years old showed the highest peak values whereas neonates were those with the lowest troughs. AUCintra/MIC correlated with age(r:0.36, p = 0.02), weight(r:0.35, p = 0.03), intraoperative protein value(r:0.40, p = 0.01), CPB priming volume/kg(r:−0.33, p = 0.04), CPB duration(r:0.36, p = 0.02) and vancomycin troughs(r:0.35, p = 0.04). Conclusions: An AUCintra/MIC ⩾400 target was not reached in one-quarter of children undergoing heart surgery. Vancomycin peaked before the start of surgery and neonates were those with the lowest troughs. Vancomycin concentrations are affected by CPB hemodilution and by patients’ age and weight.

scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

Normal and abnormal trans-oxygenator pressure gradients during cardiopulmonary bypass

Perfusion ◽  
2003 ◽  
Vol 18 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Anthony Richard Fisher ◽  
Mya Baker ◽  
Mike Buffin ◽  
Patrick Campbell ◽  
Stephen Hansbro ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Prospective Study ◽  
Pressure Gradient ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Normal Pressure ◽  
Pressure Gradients ◽  
Open Heart ◽  
A Prospective Study

A prospective study was conducted with the aims of 1) determining the normal trans-oxygenator pressure gradient characteristics for a range of oxygenators and 2) determining the characteristics, incidence and outcome of abnormally raised gradients. The trans-oxygenator pressure gradient was monitored in 3684 patients undergoing open-heart surgery in eight different hospitals. When the normal pressure gradient was measured during cardiopulmonary bypass in mmHg/L blood flow, a constant figure was obtained which was specific for each oxygenator. This gradient was abnormally raised in 16 cases (one in every 230 cases) and was raised to such an extent in three of these cases that an emergency oxygenator changeout was required (one in every 1228 cases). Among the 16 reported incidents, three different patterns of gradient changes occurred, suggesting the possibility that there were three different aetiologies. In nine of these incidents, the pressure gradient was normal immediately upon going on bypass, but rose rapidly to a plateau value, which then returned to the normal value within 40 minutes. In three cases, the pressure gradient was raised immediately upon going on bypass and then rapidly returned to the baseline. In one case, the pressure gradient was raised immediately upon going on bypass and stayed raised throughout the operation.

scholarly journals Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Alessandro Varrica ◽  
Angela Satriano ◽  
Alessandro Frigiola ◽  
Alessandro Giamberti ◽  
Guido Tettamanti ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Neurological Disorders ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Serum Levels ◽  
S100b Protein ◽  
Perioperative Monitoring ◽  
A Prospective Study

Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD) newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB), has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels.Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN) measurement were drawn at five perioperative time-points.Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak(P<0.01)during CPB and at the end of the surgical procedure. Moreover, ADN showed a flat pattern and no significant differences(P>0.05)have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery.Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

scholarly journals Pharmacokinetics of ε-Aminocaproic Acid in Neonates Undergoing Cardiac Surgery with Cardiopulmonary Bypass

2015 ◽  
Vol 122 (5) ◽  
pp. 1002-1009 ◽  
Author(s):  
Michael P. Eaton ◽  
George M. Alfieris ◽  
Dawn M. Sweeney ◽  
Ronald E. Angona ◽  
Jill M. Cholette ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Plasma Concentrations ◽  
Aminocaproic Acid ◽  
Parameter Estimates ◽  
Loading Dose ◽  
Dosing Regimen ◽  
Pediatric Heart Surgery ◽  
Drug Concentrations

Abstract Background: Antifibrinolytic medications such as ε-aminocaproic acid (EACA) are used in pediatric heart surgery to decrease surgical bleeding and transfusion. Dosing schemes for neonates are often based on adult regimens, or are simply empiric, in part due to the lack of neonatal pharmacokinetic information. The authors sought to determine the pharmacokinetics of EACA in neonates undergoing cardiac surgery and to devise a dosing regimen for this population. Methods: Ten neonates undergoing cardiac surgery with cardiopulmonary bypass were given EACA according to standard practice, and blood was drawn at 10 time points to determine drug concentrations. Time-concentration profiles were analyzed using nonlinear mixed effects models. Parameter estimates (standardized to a 70-kg person) were used to develop a dosing regimen intended to maintain a target concentration shown to inhibit fibrinolysis in neonatal plasma (50 mg/l). Results: Pharmacokinetics were described using a two-compartment model plus an additional compartment for the cardiopulmonary bypass pump. First-order elimination was described with a clearance of 5.07 l/h × (WT/70)0.75. Simulation showed a dosing regimen with a loading dose of 40 mg/kg and an infusion of 30 mg · kg−1 · h−1, with a pump prime concentration of 100 mg/l maintained plasma concentrations above 50 mg/l in 90% of neonates during cardiopulmonary bypass surgery. Conclusions: EACA clearance, expressed using allometry, is reduced in neonates compared with older children and adults. Loading dose and infusion dose are approximately half those required in children and adults.

scholarly journals Safety of Normothermic Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A System Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Tao Xiong ◽  
Lei Pu ◽  
Yuan-Feng Ma ◽  
Yun-Long Zhu ◽  
Xu Cui ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Congenital Heart Surgery ◽  
Mean Difference ◽  
Pediatric Cardiac Surgery ◽  
Controlled Trials ◽  
Cochrane Central Register

Objectives: Hypothermic cardiopulmonary bypass (HCPB) has been used successfully in cardiac surgery for more than half a century, although adverse effects have been reported with its use. Many studies on temperature management during CPB published to date have shown that normothermic CPB (NCPB) provides more benefits to children undergoing cardiac surgery. The present meta-analysis investigated the effect of NCPB on clinical outcomes based on results of randomized controlled trials and observational studies on pediatric cardiac surgery.Methods: Databases such as PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov were searched from inception to May 2021 to identify relevant studies published in English.Results: The present meta-analysis included 13 studies characterizing a total of 837 pediatric patients. The random effects model exhibited that the NCPB group had reduced revision for postoperative bleeding [odds ratio (OR): 0.11; 95% confidence interval (CI): 0.01–0.89; I2 = 0%, P = 0.04], serum lactate 2–4 h after CPB (mean difference: −0.60; 95% CI: −1.09 to −0.11; I2 = 82%, P = 0.02), serum creatinemia 24 h after CPB (mean difference: −2.73; 95% CI: −5.06 to −0.39; I2 = 83%, P = 0.02), serum creatinemia 48 h after CPB (mean difference: −2.08; 95% CI: −2.78 to −1.39; I2 = 0%, P &lt; 0.05), CPB time (mean difference: −19.10, 95% CI: −32.03 to −6.18; I2 = 96%, P = 0.04), and major adverse events (OR: 0.37; 95% CI: 0.15–0.93; Z = 2.12, P = 0.03) after simple congenital surgery compared with the HCPB group.Conclusion: NCPB is as safe as HCPB in pediatric congenital heart surgery. Moreover, NCPB provides more advantages than HCPB in simple congenital heart surgery.

Nutrition Support After Cardiac Surgery: Lessons Learned From a Prospective Study

2020 ◽  
Author(s):  
Chin Siang Ong ◽  
Pooja Yesantharao ◽  
Patricia M. Brown ◽  
Joseph K. Canner ◽  
T. Andrew Brown ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prospective Study ◽  
Lessons Learned ◽  
Nutrition Support ◽  
A Prospective Study

scholarly journals Jaundice after open heart surgery: a prospective study.

Thorax ◽  
1985 ◽  
Vol 40 (1) ◽  
pp. 80-80 ◽  
Author(s):  
W Klepetko ◽  
J Miholic
Keyword(s):  
Prospective Study ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
A Prospective Study
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