scholarly journals Analysis of online gas monitoring CDI 500® and SYSTEM M-M4®. Are they comparable tools for clinical perfusion practice?

2019 ◽  
pp. 21-27 ◽  
Author(s):  
Maria Luz Recio ◽  
Maria Carmen Santos ◽  
Carlos Casado ◽  
Juan Carlos Santos
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Prospective Observational Study ◽  
Venous Blood ◽  
Blood Gases ◽  
Reliable Data ◽  
Direct Evaluation ◽  
Two Samples ◽  
Evaluation Of Data

Objective: to compare the data obtained from the CDI500® and Spectrum M4® to assess the reliability of the results and their impact on cardiopulmonary bypass. Methods: a prospective observational study of patients undergoing cardiac surgery with CPB was conducted between January-2017 and February-2018. The data provided by CDI and M4 was collected. Arterial and venous blood gases taken from Radiometer ABL90 Flex® were used as control. With the first sample, the data of both analyzers were adjusted. A minimum of two samples and a maximum of four were made. Results: 100 patients and 292 samples (32% women) with a mean age of 65.2 ± 11.5 years were studied. The parameters of the CDI and M4 practically did not present significant differences after the first adjustment, and without affecting the clinical practice, except in the bicarbonate and the excess of base where CDI does not adjust to the values. The analysis was done with the Bland/Altman charts, the PCO2 and PO2 were better measured by the CDI while Hto, Hb and SvO2 by M4, which was corroborated comparing the error percentages less than ± 5% in both systems, the significant differences being in the five parameters. Conclusions: both systems provide reliable data, although they require a previous calibration. The M4 allows direct evaluation of data to help a goal directed perfusion.

Effects of ventilation and nonventilation on pulmonary venous blood gases and markers of lung hypoxia in humans undergoing total cardiopulmonary bypass

2000 ◽  
Vol 28 (5) ◽  
pp. 1336-1340 ◽  
Author(s):  
Stephan A. Loer ◽  
Gerhard Kalweit ◽  
Jörg Tarnow
Keyword(s):  
Cardiopulmonary Bypass ◽  
Venous Blood ◽  
Blood Gases

Air Embolism on Cardiopulmonary Bypass

2019 ◽  
pp. 160-165
Author(s):  
Aaron Hudson ◽  
Ryan Hood
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Sudden Death ◽  
Air Embolism ◽  
Cardiac Surgical Procedures ◽  
Daily Basis ◽  
Team Members ◽  
Cardiac Surgeons ◽  
Almost All

The danger associated with air embolism in cardiac surgery has been well established for over 125 years. In the first volume of Annals of Surgery, published in 1885, long preceding the era of cardiac surgery and the use of extracorporeal circulatory techniques, Dr. Nicholas Senn alluded to the ensuing calamity caused by air embolism: “I intend on this occasion to call your attention to one of the most dreaded and, I may add, one of the most uncontrollable causes of sudden death—I allude to air-embolism.”1,2 Since the advent of modern cardiac surgery, much attention has been focused on the prevention of air embolism by cardiac surgeons, anesthesiologists, and perfusionists alike. Indeed, all three team members are critically responsible for the safe conduct of thousands of cardiac surgical procedures occurring on a daily basis worldwide. While the morbidity and mortality of massive air embolism is exceedingly high, most believe that with appropriate training and unwavering vigilance during clinical practice, almost all massive air emboli can be prevented.3

scholarly journals Vasoresponsiveness in patients with heart failure (VASOR): protocol for a prospective observational study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Marieke E. van Vessem ◽  
Saskia L. M. A. Beeres ◽  
Rob B. P. de Wilde ◽  
René de Vries ◽  
Remco R. Berendsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Observational Study ◽  
Vascular Reactivity ◽  
Prospective Observational Study ◽  
Ex Vivo ◽  
Phase 1 ◽  
Resistance Arteries ◽  
Patients With Heart Failure

Abstract Background Vasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with heart failure, before, during and after heart failure surgery and to identify the etiological factors involved. Methods This is a prospective, observational study conducted at Leiden University Medical Center. Patients with and patients without heart failure undergoing cardiac surgery on cardiopulmonary bypass are enrolled. The study is divided in two inclusion phases. During phase 1, 18 patients with and 18 patients without heart failure are enrolled. The vascular reactivity in response to a vasoconstrictor (phenylephrine) and a vasodilator (nitroglycerin) is assessed in vivo on different timepoints. The response to phenylephrine is assessed on t1 (before induction), t2 (before induction, after start of cardiotropic drugs and/or vasopressors), t3 (after induction), t4 (15 min after cessation of cardiopulmonary bypass) and t5 (1 day post-operatively). The response to nitroglycerin is assessed on t1 and t5. Furthermore, a sample of pre-pericardial fat tissue, containing resistance arteries, is collected intraoperatively. The ex vivo vascular reactivity is assessed by constructing concentrations response curves to various vasoactive substances using isolated resistance arteries. Next, expression of signaling proteins and receptors is assessed using immunohistochemistry and mRNA analysis. Furthermore, the groups are compared with respect to levels of organic compounds that can influence the cardiovascular system (e.g. copeptin, (nor)epinephrine, ANP, BNP, NTproBNP, angiotensin II, cortisol, aldosterone, renin and VMA levels). During inclusion phase 2, only the ex vivo vascular reactivity test is performed in patients with (N = 12) and without heart failure (N = 12). Discussion Understanding the difference in vascular responsiveness between patients with and without heart failure in detail, might yield therapeutic options or development of preventive strategies for vasoplegia, leading to safer surgical interventions and improvement in outcome. Trial registration The Netherlands Trial Register (NTR), NTR5647. Registered 26 January 2016.

scholarly journals 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery: a tool to better clinical practice

2020 ◽  
Vol 57 (2) ◽  
pp. 207-209 ◽  
Author(s):  
Robert A Baker ◽  
Aleksandar Nikolic ◽  
Francesco Onorati ◽  
R Peter Alston
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Cardiopulmonary Bypass ◽  
Adult Cardiac Surgery

Serum level of sCD163, a soluble receptor for hemoglobin, is influenced by cardiac surgery

Perfusion ◽  
2009 ◽  
Vol 24 (4) ◽  
pp. 263-269 ◽  
Author(s):  
Martina Kolackova ◽  
Vladimir Lonsky ◽  
Manuela Trojackova Kudlova ◽  
Jiri Mandak ◽  
Pavel Kunes ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Serum Level ◽  
Artery Bypass ◽  
Venous Blood ◽  
Serum Levels ◽  
The Body ◽  
Soluble Form ◽  
Surgical Approaches ◽  
Off Pump

Background:The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocytes/ macrophages, is shed to the body fluids in a soluble form (sCD163). Objectives: To evaluate the dynamics of sCD163 in the blood of patients undergoing cardiac surgery. Patients and Methods: Sixty-one adult patients who underwent coronary artery bypass grafting (CABG) were enrolled in the study. They were assigned to undergo CABG using either cardiopulmonary bypass (CPB), “on-pump”, (22 patients), modified CPB, mini “on-pump”, (17 patients) or without CPB, “off-pump”, (22 patients) surgery. Serum levels of sCD163 in venous blood samples taken before and after surgery, and during an early postoperative period, were evaluated by Macro 163TM diagnostic kit (IQ Products, Groningen, NL). Results: Compared to the preoperative levels (“on-pump”; 344 ng/mL, “off-pump”; 314.5 ng/mL, mini-invasive “on-pump”; 336.5 ng/mL) serum levels were elevated at the finish of surgery, reaching maximum at the 1st postoperative day (“onpump”; 658 ng/mL; p<0.05, “off-pump”; 810.5 ng/mL; p<0.01; mini-invasive “on-pump”; 663 ng/mL; non-significant). No significant differences regarding the serum levels of sCD163 between different surgical approaches were found. Conclusion: Serum level of sCD163 scavenger molecule for hemoglobin is elevated at the end of surgery and at the 1st postoperative day, being little influenced by cardiopulmonary bypass.

scholarly journals Oxygen delivery during cardiopulmonary bypass and acute kidney injury: Preliminary Study

2019 ◽  
pp. 5-11
Author(s):  
Juan Carlos Santos ◽  
Maria Carmen Santos ◽  
Carlos Casado ◽  
Maria Luz Recio ◽  
Antonio Cabrera ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Oxygen Delivery ◽  
Kidney Injury ◽  
Blood Gases ◽  
Post Cardiopulmonary Bypass ◽  
O2 Delivery

Objective: to assess the relationship between oxygen delivery during cardiopulmonary bypass and the incidende of acute kidney injury in the immediate postoperative period of patients undergoing cardiac surgery, as well as to identify possible risk factors. Methods: A retrospective observational study of patients undergoing cardiac surgery scheduled between May 2016 and February 2018 was carried out in which the M-M4 System was used for online blood gases. Patients with preoperative diagnosis of chronic renal failure were excluded. For the oxigen delivery, the average of all M4 records was made. Results: 133 patients (35.3% women) with a mean age of 64.9 ± 10.9 years were studied. The incidence of acute kidney injury was 18.8% (AKI I: 12%; AKI II: 3%; AKI III: 3.8%). There was no correlation between acute kidney injury and O2 delivery (251 ± 43 vs 247 ± 52, ns), if there was a difference when patients needed renal replacement therapy (251 ± 43 vs 198 ± 18, p = 0.04). There was a significant increase risk in diabetes; HTA; pulmonary arterial hypertension; chronic atrial fibrilation; red blood cell concentrate and blood products administration in the operating room; redo for bleeding; high lactic acid and glycemia post cardiopulmonary bypass; prolonged pump and ischemia times; and combined surgery. Conclusions: There was no direct relationship between O2 delivery and acute kidney injury, although there was a significantly lower O2 delivery in patients who needed postoperative renal replacement therapy.

Cerebrovascular autoregulation impairments during cardiac surgery with cardiopulmonary bypass are related to postoperative cognitive deterioration: prospective observational study

2019 ◽  
Vol 85 (6) ◽  
Author(s):  
Birute Kumpaitiene ◽  
Milda Svagzdiene ◽  
Edmundas Sirvinskas ◽  
Virginija Adomaitiene ◽  
Vytautas Petkus ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Cognitive Deterioration ◽  
Cerebrovascular Autoregulation

scholarly journals Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery: a prospective observational study

Critical Care ◽  
2011 ◽  
Vol 15 (1) ◽  
pp. R69 ◽  
Author(s):  
David J Klein ◽  
Francoise Briet ◽  
Rosane Nisenbaum ◽  
Alexander D Romaschin ◽  
C David Mazer
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Risk Of Infection ◽  
Increased Risk

scholarly journals The Relationship between Arterial and Central Venous Blood Gases Values in Patients Undergoing Mechanical Ventilation after Cardiac Surgery

2018 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mohammadamin Valizad Hassanloei ◽  
Alireza Mahoori ◽  
Nazli Karami ◽  
Venus Sina
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Venous Blood ◽  
Blood Gases ◽  
Central Venous ◽  
Central Venous Blood ◽  
The Relationship

Abstract 15823: Diminished Vasoresponsiveness in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Olga Papazisi ◽  
Marieke E van Vessem ◽  
Saskia L Beeres ◽  
Rob B de Wilde ◽  
Remco R Berendsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Clinical Outcome ◽  
Prospective Observational Study ◽  
Independent Predictor ◽  
Medical Center ◽  
Vascular Response ◽  
Patients With Heart Failure ◽  
Vascular Responsiveness

Introduction: Vasoplegia is a severe complication after cardiac surgery and is associated with impaired clinical outcome. Pre-operative heart failure (HF) is considered an independent predictor of post-operative vasoplegia. We hypothesize that HF patients are more susceptible to vasoplegia due to altered vascular responsiveness. In this study, vasoresponsiveness in patients undergoing cardiac surgery for HF is investigated. Methods: A prospective, observational study was conducted at Leiden University Medical Center. We included patients with HF (N=18) and without HF (N=18) who underwent cardiac surgery on cardiopulmonary bypass. Vasoresponsiveness was assessed at 4 different timepoints: 1) before induction, 2) after induction, 3) after cessation of cardiopulmonary bypass and 4) on the first postoperative day. The vascular response was recorded as change in systemic vascular resistance (SVR) after the administration of phenylephrine (bolus 2 μg/kg). Results: Thirty-six patients were included [67 (61-71) years, 78% male]. Vascular responsiveness was significantly attenuated in patients with HF compared to controls. The response to phenylephrine was already diminished at baseline in HF patients and was almost abolished after cessation of cardiopulmonary bypass (Figure). Roughly the same pattern of vasoresponsiveness was found when excluding patients that received norepinephrine. Moreover, HF patients required a significantly higher amount of noradrenaline [169.80 (IQR 14.77-318.97) ug/kg] compared to controls [3.61 (IQR 0-41.60) ug/kg] to maintain similar SVR during the first 24h postoperatively. Conclusions: The vascular responsiveness is altered in patients with HF and this might explain the higher prevalence of vasoplegia in this patient population.

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