Subzero balance: simple modified ultrafiltration (SBUF-SMUF) technique for pediatric cardiopulmonary bypass

The use of cardiopulmonary bypass (CPB) can be associated with significant hemodilution, coagulopathy and a systemic inflammatory response for infants and children undergoing cardiac surgery. Intra-operative ultrafiltration has been used for decades to ameliorate these harmful effects. The novel combination of a continuous and non-continuous form of ultrafiltration, Subzero Balance Simple Modified Ultrafiltration (SBUF-SMUF) here described, seeks to enhance recovery from pediatric cardiac surgery and CPB.

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Modulation of Systemic Inflammatory Response after Cardiac Surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300422 ◽

2005 ◽

Vol 13 (4) ◽

pp. 382-395 ◽

Cited By ~ 50

Author(s):

Shahzad G Raja ◽

Gilles D Dreyfus

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Inflammatory Reaction ◽

Therapeutic Strategies ◽

Systemic Inflammatory Response ◽

Whole Body ◽

Hemodynamic Stability ◽

Immunomodulatory Agents ◽

Considerable Research

Cardiac surgery and cardiopulmonary bypass initiate a systemic inflammatory response largely determined by blood contact with foreign surfaces and the activation of complement. It is generally accepted that cardiopulmonary bypass initiates a whole-body inflammatory reaction. The magnitude of this inflammatory reaction varies, but the persistence of any degree of inflammation may be considered potentially harmful to the cardiac patient. The development of strategies to control the inflammatory response following cardiac surgery is currently the focus of considerable research efforts. Diverse techniques including maintenance of hemodynamic stability, minimization of exposure to cardiopulmonary bypass circuitry, and pharmacologic and immunomodulatory agents have been examined in clinical studies. This article briefly reviews the current concepts of the systemic inflammatory response following cardiac surgery, and the various therapeutic strategies being used to modulate this response.

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Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2002.121285 ◽

2002 ◽

Vol 123 (4) ◽

pp. 648-654 ◽

Cited By ~ 35

Author(s):

P. Tassani ◽

A. Barankay ◽

F. Haas ◽

S.U. Paek ◽

M. Heilmaier ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Systemic Inflammatory Response ◽

Low Flow

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The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

Perfusion ◽

10.1191/0267659102pf543oa ◽

2002 ◽

Vol 17 (2) ◽

pp. 103-109 ◽

Cited By ~ 49

Author(s):

Armin Sablotzki ◽

Ivar Friedrich ◽

Jörg Mühling ◽

Marius G Dehne ◽

Jan Spillner ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Heart Surgery ◽

Open Heart Surgery ◽

Multiple Organ ◽

Systemic Inflammatory Response ◽

Apache Ii Score ◽

Organ Dysfunctions

Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1β, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocar-dial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1β) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.

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Nucleated red blood cells after cardiopulmonary bypass in infants and children: is there a relationship to the systemic inflammatory response syndrome?

Perfusion ◽

10.1177/026765919901400304 ◽

1999 ◽

Vol 14 (3) ◽

pp. 173-180 ◽

Cited By ~ 6

Author(s):

Bernhard Frey ◽

Trevor Duke ◽

Stephen B Horton

Keyword(s):

Cardiopulmonary Bypass ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Red Blood Cells ◽

Blood Cells ◽

Systemic Inflammatory Response ◽

Infants And Children ◽

Retrospective Case ◽

Nucleated Red Blood Cells ◽

Age Range

In a retrospective case control study we aimed to evaluate whether infants and children with nucleated red blood cells (NRBCs) in their peripheral blood smears after cardiopulmonary bypass (CPB) had longer bypass times than controls without NRBCs. On review of a 3-year period, 58 children with NRBCs after CPB (and without NRBCs prior to CPB) were identified (cases). A random sample of 100 children without NRBCs after CPB over the same period served as controls. The median age (range) of the children with NRBCs and without NRBCs was 0.6 years (2 days to 20 years) and 1.4 years (2 days to 16 years), respectively ( p = 0.03). The children with NRBCs had a significantly longer bypass time than the controls (mean, standard deviation (SD): 114 min, 50 vs 79 min, 46 min; p < 0.0001). For the patients with postoperative polychromasia alone, the mean CPB time (111 min, SD 46 min) was also significantly longer than the respective time in the controls ( p < 0.001). Markers of organ dysfunction (renal failure, use of inotropic support, time of endotracheal intubation, stay in intensive care unit and stay in hospital) were significantly more frequent/longer in the NRBC group. Post-CPB release of NRBCs is associated with longer CPB time. This alteration may be part of the CPB-related systemic inflammatory response syndrome.

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