Risk factors and treatment of oxygenator high-pressure excursions during cardiopulmonary bypass

Introduction: A high-pressure excursion (HPE) is a sudden increase in oxygenator inlet pressure during cardiopulmonary bypass (CPB). The aims of this study were to identify factors associated with HPE, to describe a treatment protocol utilizing epoprostenol in severe cases, and to assess early outcome in HPE patients. Methods: Patients who underwent cardiac surgery with cardiopulmonary bypass at Sahlgrenska University Hospital 2016–2018 were included in a retrospective observational study. Pre- and post-operative data collected from electronic health records, local databases, and registries were compared between HPE and non-HPE patients. Factors associated with HPE were identified with logistic regression models. Results: In total, 2024 patients were analyzed, and 37 (1.8%) developed HPE. Large body surface area (adjusted Odds Ratio (aOR): 1.43 per 0.1 m2; 95% confidence interval (CI): 1.16–1.76, p < 0.001), higher hematocrit during CPB (aOR: 1.20 per 1%; (1.09–1.33), p < 0.001), acute surgery (aOR: 2.98; (1.26–6.62), p = 0.018), and previous stroke (aOR: 2.93; (1.03–7.20), p = 0.027) were independently associated with HPE. HPE was treated with hemodilution ( n = 29, 78.4%), and/or extra heparin ( n = 23, 62.2%), and/or epoprostenol ( n = 12, 32.4%). No oxygenator change-out was necessary. While there was no significant difference in 30-day mortality (2.7% vs 3.2%, p = 1.0), HPE was associated with a higher perioperative stroke rate (8.1% vs 1.8%, aOR 5.09 (1.17–15.57), p = 0.011). Conclusions: Large body surface area, high hematocrit during CPB, previous stroke and acute surgery were independently associated with HPE. A treatment protocol including epoprostenol appears to be a safe option. Perioperative stroke rate was increased in HPE patients.

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Characterization of severely burned patients and evaluation of factors associated to mortality. An observational retrospective cohort study in San Vicente Fundación Hospital

Trauma ◽

10.1177/14604086211046464 ◽

2021 ◽

pp. 146040862110464

Author(s):

Juan M Robledo Cadavid ◽

Laura Salgado Flórez ◽

Juan C Garcés Echeverri ◽

Jorge E Ruiz Santacruz ◽

Olga H Hernandez Ortiz

Keyword(s):

Cohort Study ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Ventilatory Support ◽

Kidney Injury ◽

Factors Associated ◽

Care Systems

Introduction Burns are common in developing countries and place a large burden on the medical and social care systems. However, information about management and outcomes from such countries is scarce. The purpose of this study was to analyze the epidemiology and main factors related to the mortality in severely burned patients at the Hospital Universitario San Vicente Fundación in Medellín, Colombia. Methods An observational retrospective cohort study was conducted. To establish prognostic factors associated with mortality, we analyzed variables such as age, sex, burned surface, and degree of burn, among others. Demographic, clinic, and management features as well as complications and factors associated with mortality were analyzed using logistic regression. Results 4516 clinical histories were reviewed, 225 were included in the study. 76.9% were men, with a median age of 35 years; 64.9% were fire burns. The median burned body surface area was 42%. There were inhalation injuries in 135 patients and ocular in 106 patients. The main complication was infection followed by rhabdomyolysis. The overall hospital stay was 27 days, and the median length of stay at the intensive care unit was 7 days with in-hospital mortality of 30.7%. The variables associated with mortality were age, burned body surface area, degree of burn, and kidney injury. Surgical intervention was protective. Conclusions Severely burned patients in our hospital have similar outcomes and, in some cases, better outcomes than those reported in the literature in countries with similar characteristics, and we have seen that in the last years, there has been a better experience in the management of these patients. Elderly, extension, and depth of burnt tissue are markers of poor outcomes. Early surgery and intubation have shown better outcomes, probably due to infection control and removal of necrotic tissue, airway management, and ventilatory support for metabolic and hemodynamic derangement.

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Early excision and grafting, an alternative approach to the surgical management of large body surface area levamisole-adulterated cocaine induced skin necrosis

Burns ◽

10.1016/j.burns.2014.10.032 ◽

2015 ◽

Vol 41 (3) ◽

pp. e34-e40 ◽

Cited By ~ 10

Author(s):

Jason Miner ◽

Paul Gruber ◽

Travis L. Perry

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Surgical Management ◽

Body Surface ◽

Skin Necrosis ◽

Large Body ◽

Alternative Approach

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Changes in diaphragm polyinositol phosphates caused by a large body surface area burn

Burns ◽

10.1016/0305-4179(93)90098-s ◽

1993 ◽

Vol 19 (1) ◽

pp. 35-42 ◽

Cited By ~ 7

Author(s):

J.F. Tomera ◽

K. Lilford ◽

S.P. Kukulka

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Large Body

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The acute surgical management of injury to the helix and antihelix in patients with large body surface area burns

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2008.01.010 ◽

2009 ◽

Vol 62 (8) ◽

pp. 1020-1024 ◽

Cited By ~ 7

Author(s):

Tamotsu Saito ◽

Takatoshi Yotsuyanagi ◽

Kyori Ezoe ◽

Kanae Ikeda ◽

Makoto Yamauchi ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Surgical Management ◽

Body Surface ◽

Large Body

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Anthropometry, Body Surface Area and Cardiopulmonary Bypass: Determining the Pump Flow Rate of the Heart–Lung Machine Using Body Size

Handbook of Anthropometry ◽

10.1007/978-1-4419-1788-1_132 ◽

2012 ◽

pp. 2155-2170

Author(s):

R. Peter Alston

Keyword(s):

Body Size ◽

Cardiopulmonary Bypass ◽

Surface Area ◽

Body Surface Area ◽

Flow Rate ◽

Body Surface ◽

Pump Flow ◽

Pump Flow Rate ◽

Heart Lung Machine ◽

Lung Machine

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Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?

Perfusion ◽

10.1177/0267659110382062 ◽

2010 ◽

Vol 26 (1) ◽

pp. 45-50 ◽

Cited By ~ 5

Author(s):

SA Thomassen ◽

A. Larsson ◽

JJ Andreasen ◽

W. Bundgaard ◽

M. Boegsted ◽

...

Keyword(s):

Blood Flow ◽

Cardiopulmonary Bypass ◽

Surface Area ◽

Body Surface Area ◽

Body Surface

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A minimal priming technique that allows for a higher circulating hemoglobin on cardiopulmonary bypass

Perfusion ◽

10.1177/026765919801300505 ◽

1998 ◽

Vol 13 (5) ◽

pp. 311-313 ◽

Cited By ~ 11

Author(s):

Michael J Cromer ◽

Dennis R Wolk

Keyword(s):

Cardiopulmonary Bypass ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Low Cost ◽

Blood Products ◽

Priming Volume ◽

Patient Refusal ◽

To Receive ◽

Anemia Patient

Reduction in circuit prime during cardiopulmonary bypass has benefits for the patient with a low body surface area, anemia, patient refusal to receive blood products, and aids the practitioner’s goal to minimize exposure to blood products. Described here is a simple, low-cost technique that has been shown to decrease priming volume in any bypass circuit and allow a significant increase in ‘on bypass hemoglobin’.

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