| 1. |
- Andersen, Leon, et al.
(författare)
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Our initial experience of monitoring the autoregulation of cerebral blood flow during cardiopulmonary bypass
- 2023
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Ingår i: The journal of extra-corporeal technology. - : EDP Sciences. - 0022-1058. ; 55:4, s. 209-217
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cerebral blood flow (CBF) is believed to be relatively constant within an upper and lower blood pressure limit. Different methods are available to monitor CBF autoregulation during surgery. This study aims to critically analyze the application of the cerebral oxygenation index (COx), one of the commonly used techniques, using a reference to data from a series of clinical registrations.METHOD: CBF was monitored using near-infrared spectroscopy, while cerebral blood pressure was estimated by recordings obtained from either the radial or femoral artery in 10 patients undergoing cardiopulmonary bypass. The association between CBF and blood pressure was calculated as a moving continuous correlation coefficient. A COx index > 0.4 was regarded as a sign of abnormal cerebral autoregulation (CA). Recordings were examined to discuss reliability measures and clinical feasibility of the measurements, followed by interpretation of individual results, identification of possible pitfalls, and suggestions of alternative methods.RESULTS AND CONCLUSION: Monitoring of CA during cardiopulmonary bypass is intriguing and complex. A series of challenges and limitations should be considered before introducing this method into clinical practice.
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| 2. |
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| 3. |
- Appelblad, Micael, 1961-
(författare)
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Fat contamination of pericardial suction blood in cardiac surgery : clinical and experimental studies in perspectives of transfusion logistics
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: During cardiac surgery aided by cardiopulmonary bypass (CPB) the autotransfusion of pericardial suction blood (PSB) is regarded mandatory to limit allogeneic blood exposure. PSB is however proposed as a source of lipid microemboli and to contribute to brain damage. This thesis addresses the logistics of allogeneic blood transfusion during coronary artery bypass grafting (CABG), the embolic potential of reinfused PSB, and means to reduce PSB fat contamination, investigated both clinically and experimentally. Methods: Study I) Patients undergoing CABG surgery (n=2469) were included in a database study. The magnitude of surgical bleeding versus blood transfusion was analyzed to extract a subgroup of patients (n=982) in whom transfusions were independent from bleeding. Study II) PSB and venous-blood samples were collected from patients undergoing routine CABG (n=20). The in vitro capillary-flow properties of blood subcomponents and the effects of routine screen filtration were tested. PSB fat contamination was evaluated by imprint microscopy. Study III) Heat extracted liquid human fat or soya oil were mixed with mediastinal drain blood (n=20) and incubated in a temperature controlled column, to evaluate spontaneous density separation of fat. Study IV) The findings from study-III were applied to develop a fat-reducing system (FRS) using two stacked compartments. The FRS was experimentally tested (n=12), with similar methods as in study-III, and clinically evaluated (n=10). A single-chamber blood bag (n=10) served as reference. Results: Study I) A surgical bleeding of less than 400 mL showed no correlation to blood transfusion, although 64 of 982 patients still received allogeneic blood. The strongest predictors for this kind of transfusion were; female gender, weight ≤70 kg, CPB time ≥90 minutes, CPB temperature ≤32 ºC, and advanced age (P<.001 - .038). Study II) The capillary-flow profile of PSB plasma was highly impaired compared to venous plasma (P<.001). Conversely, blood-cell components showed no difference between PSB and venous blood. Routine screen filtration showed no ameliorating effect on capillary-flow resistance. Fat debris was detected on imprints in all PSB samples in contrast to venous plasma (P<.05). Study III) After 10-min of incubation had 77% of added soya oil separated and found contained in the top 20% fraction of blood (P<.001), aimed to be discarded. The density separation of human fat was less efficient compared to soya oil (P=.011). Fat also adsorbed to surface which was more pronounced at low temperature (P<.001). The overall reduction of human fat was 70%. Study IV) PSB contained 1.5 mL fat suspended in 418 mL PSB. Of this fat was 24% surface-bound. Experimental analysis of the proposed FRS revealed an 83% fat-reduction which was clinically confirmed, suggesting 80% reduction (P=.001). The FRS also gave a small but significant erythrocyte-concentrating effect. Conclusions: Transfusion of allogeneic blood during CABG surgery appeared associated with an institutional, individual, and technical bias of an anticipated need and not only used to compensation for surgical bleeding. In part may this reflect a non-compliant CPB methodology and hemodilution. It was confirmed that PSB plasma contained fat, with a suggested embolic potential. Human fat was significantly reduced from mediastinal drain blood by spontaneous density separation and surface adsorption. The prototype FRS used for PSB incubation during CPB allowed an efficient fat reduction.
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| 4. |
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| 5. |
- Claesson Lingehall, Helena, 1965-, et al.
(författare)
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Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium? : A double blinded randomised controlled trial
- 2023
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 57:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Postoperative delirium (POD) is common after cardiac surgery. We have previously identified plasma sodium concentration and the volume of infused fluids during surgery as possible risk factors. Both are linked to the selection and composition of the pump prime used for cardiopulmonary bypass (CPB). Present study aims to examine whether hyperosmolality increases the risk for POD.Design: Patients ≥65 years (n = 195) scheduled for cardiac surgery were prospectively enrolled into this double blinded randomised clinical trial. Study group received a pump prime containing mannitol and ringer-acetate (966 mOsmol) (n = 98) vs. ringer-acetate (388 mOsmol) (n = 97) in the control group. Postoperative delirium was defined according to DSM-5 criteria based on a test-battery pre- and postoperatively (days 1–3). Plasma osmolality was measured on five occasions and coordinated with the POD assessments. The primary outcome was the POD incidence related to hyperosmolality as the secondary outcome.Results: The incidence of POD was 36% in the study group and 34% in the control group, without intergroup difference (p=.59). The plasma osmolality was significantly higher in the study group, both on days 1 and 3 and after CPB (p<.001). Post hoc analysis indicated that high osmolality levels increased the risk for delirium on day 1 by 9% (odds ratio (OR) 1.09, 95% CI 1.03–1.15) and by 10% on day 3 (OR 1.10, 95% CI 1.04–1.16).Conclusions: Use of a prime solution with high osmolality did not increase the incidence of POD. However, the influence of hyperosmolality as a risk factor for POD warrants further investigation.
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| 6. |
- Engström, Gunnar, et al.
(författare)
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Fat reduction in pericardial suction blood by spontaneous density separation : an experimental model on human liquid fat versus soya oil
- 2003
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Ingår i: Perfusion. - : SAGE Publications. - 0267-6591 .- 1477-111X. ; 18:1, s. 39-45
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Tidskriftsartikel (refereegranskat)abstract
- Pericardial suction blood (PSB) contains mediastinal liquid wound fat with an embolic potential to cause brain damage after cardiopulmonary bypass (CPB). The aims were to measure how fat separates spontaneously from blood by density and how temperature and fat surface adhesion affect the results under experimental conditions. Human liquid fat was heat-extracted from retrieved pericardial fat tissue of coronary artery bypass graft (CABG) patients ( n=10). Human fat or soya oil, 5% and 10%, respectively, were mixed with postoperatively shed mediastinal blood ( n=20). The mixture was loaded into a temperature-controlled (37°C, 20°C, 10°C) vertical separation column. At 1, 2.5, 5 and 10 minutes, the blood was collected in five fractions, representing layers of density separation, followed by centrifugation. Human fat solidified at 8°C. Soya oil remained liquid below 0°C. Soya oil separated fast in water, but was slower in blood. At 10 minutes and 37°C 73±6% of added soya oil was found in the top 20% fraction. Human fat at 37°C behaved similarly to soya oil, with 58-2% separation at 10 minutes. However, at lower temperatures the density separation became less efficient ( p<0.001), whereas human fat more effectively adhered to the walls of the column, which added to the removal. In total, 66%-78% of the human fat was removed, depending on temperature. In conclusion, fat in PSB can be reduced by simple density separation and surface adhesion while it is temporarily retained from the CPB circuit.
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| 7. |
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| 8. |
- Eriksson, Johan, et al.
(författare)
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Productivity in relation to organization of a surgical department : a retrospective observational study
- 2022
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Ingår i: BMC Surgery. - : BioMed Central (BMC). - 1471-2482. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Responsible and efficient resource utilization are important factors in healthcare. The aim of this study was to investigate how total case time differs between two differently organized surgical departments. Methods: This is a retrospective observational study of a cohort of patients undergoing elective surgery for breast cancer or malignant melanoma in a university hospital setting in Sweden. All patients were operated on by the same set of surgeons but in two different surgical departments: a general surgery (GS) and a cardiothoracic (CT) surgery department. Patients were selected to the two departments from a waiting list in the order of referral for surgery. The effect of being operated on at the CT department compared to the GS department was estimated by linear regression. Results: The final study cohort comprised 349 patients in the GS department and 177 patients in the CT department. Both groups were similar regarding surgical procedures, American Society of Anesthesiologists' score, body mass index, age, sex, and the skill level of the operating surgeon. These covariates were included in the linear regression model. The total case time, defined by the Procedural Time Glossary as room set-up start to room clean-up finish, was significantly shorter for the patients who underwent a surgical procedure at the CT department compared to the GS department, even after adjusting for the background characteristics of the patients and surgeon. After adjusting for the selected covariates, the average difference in total case time between the two departments was − 30.67 min (p = 0.001). Conclusions: A significantly shorter total case time was measured for operations in the CT department. Plausible explanations may be more beneficial organizational factors, such as staffing ratio, skill mix in the operating room team, and working behavioral aspects regarding resource utilization.
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| 9. |
- Hällgren, Oskar, et al.
(författare)
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Implementing a Statistical Model for Protamine Titration : Effects on Coagulation in Cardiac Surgical Patients
- 2017
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1053-0770 .- 1532-8422. ; 31:2, s. 516-521
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To implement a statistical model for protamine titration. DESIGN: Prospective randomized trial. SETTING: University hospital. PARTICIPANTS: Sixty (n = 30+30) patients scheduled for elective coronary artery bypass surgery were randomly assigned to 2 groups. INTERVENTIONS: Protamine dose calculated according to an algorithm established from a statistical model or to a fixed protamine-heparin dose ratio (1:1). MEASUREMENTS AND MAIN RESULTS: Both groups demonstrated comparable patient demographics and intraoperative data. Coagulation effects were evaluated using rotational thromboelastometry. Using the statistical model reduced (p<0.01) the protamine dose from 426±43 mg to 251±66 mg, followed by significantly (p<0.01) shorter intrinsic clotting time (208±29 seconds versus 244±52 seconds) and stronger clot firmness (p = 0.01), and effects on indices of extrinsic or fibrinogen coagulation pathways were insignificant. Test of residual heparin was negative in all patients after protamine administration, aligned with insignificant (p = 0.27) intergroup heparinase-verified clotting time differences. CONCLUSIONS: The statistical model for protamine titration is clinically feasible and protects the patient from exposure to excessive doses of protamine, with advantageous effects on coagulation as measured using rotational thromboelastometry. Significance regarding clinical outcome is yet to be defined.
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| 10. |
- Johagen, Daniel, et al.
(författare)
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Can the oxygenator screen filter reduce gaseous microemboli?
- 2014
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Ingår i: Journal of Extra-Corporeal Technology. - : American Society of Extra-Corporeal Technology. - 0022-1058. ; 46:1, s. 60-66
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Tidskriftsartikel (refereegranskat)abstract
- Gaseous microemboli (GME) define small bubbles as <200 μm in size. GME are reported to increase morbidity after cardiopulmonary bypass (CPB) and cardiac surgery. To prevent intrusion of GME into the systemic circulation during CPB, arterial line filtration is generally recommended. New trends in oxygenator design promote location of arterial filtration as an integral part of the oxygenator housing. The present experimental study aimed to evaluate the GME removal properties of an integrated arterial screen filter in a standard microporous oxygenator. The GME properties of Terumo Capiox® FX25 with an integrated arterial screen filter was assessed in an experimental setup and compared with Capiox® RX25, in which no arterial screen filter is present. A blood analog prime solution was recirculated using a roller pump at 4 and 6 L per minute flow rate, respectively, through a customized CPB circuit comprising oxygenator, reservoir, and connecting tubing. A controlled volume of air was introduced into the circuit. The GME activity was measured and computed using a Gampt BCC200® ultrasonic device placing one probe at the venous inlet and one other at the arterial outlet of the oxygenator. Transmembrane delta values of GME activity were used to calculate the removal efficacy based on counts and volume of GME. Use of screen filtration reduced the GME volume by 99.1% ±.1% compared with 98.0% ±.1% for controls at 4 L/min flow rate (p <.001). At 6 L/min, the reduction was 97.9% ±.1% compared with 97.0% ±.1% (p <.001). In contrast, the reduction of GME counts was less effective after screen filtration compared with controls: 89.6 ±.6% versus 91.4 ±.4% at 4 L/min and 55.6% ± 1.6% versus 76.0% ± 1.4% at 6 L/min, respectively (p <.001). The tested oxygenator with incorporated arterial screen filter reduced GME activity based on the calculated volume at the same time as counts of GME increased.
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| 11. |
- Karlsson, Mattias, et al.
(författare)
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Cardiopulmonary bypass and dual antiplatelet therapy : a strategy to minimise transfusions and blood loss
- 2020
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Ingår i: Perfusion. - : Sage Publications. - 0267-6591 .- 1477-111X. ; 35:3, s. 236-245
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions.Methods: In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn <96 hours before surgery were prospectively randomised into two equal sized groups. Cardiopulmonary bypass combined a closed Cortiva (R) heparin-coated circuit with low systemic heparinisation (activated clotting time < 250 seconds) and intraoperative cell salvage in the study group, whereas the control group used a Balance (R) coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments.Results: Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 +/- 224 versus 1,100 +/- 989 mL (p < 0.001), reduced packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin -28 +/- 15 versus -40 +/- 14 g/L (p = 0.004) and platelet loss -35 +/- 36 versus -82 +/- 67 x 10(9)/L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate (R) aggregometry, while ROTEM (R) platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences.Conclusion: A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.
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| 12. |
- Malmqvist, Gunnar, et al.
(författare)
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Cardiopulmonary bypass prime composition : beyond crystalloids versus colloids
- 2019
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Ingår i: Perfusion. - : Sage Publications. - 0267-6591 .- 1477-111X. ; 34:2, s. 130-135
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime.METHOD: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Plasma osmolality was analysed on eight occasions. A hyperosmolar CPB prime was used.RESULTS: Analyses of the perioperative plasma osmolality on eight occasions gave the following results: the preoperative osmolality level was normal (297±4 mOsm/kg); a significant increase to 322±17 mOsm/kg (p<0.001) was observed at the commencement of CPB and remained elevated after 30 minutes (310±4 mOsm/kg) and throughout the procedure (309±4 mOsm/kg); the osmolality level returned to 291±5 mOsm/kg on day 1 postoperatively and remained normal the following day (291±6 mOsm/kg).CONCLUSIONS: Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1.
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| 13. |
- Malmqvist, Gunnar, et al.
(författare)
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Fluid shifts due to the law of osmosis
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-5172 .- 1399-6576. ; 64:1, s. 137-137
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Tidskriftsartikel (refereegranskat)
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| 14. |
- Nilsson, Samuel, et al.
(författare)
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Can We Rely on the Activated Clotting Time to Measure Heparin Anticoagulation? A Clinical Evaluation of Two ACT Monitors
- 2020
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Ingår i: The journal of extra-corporeal technology. - : American Society of Extra-Corporeal Technology. - 0022-1058. ; 52:3, s. 212-217
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Tidskriftsartikel (refereegranskat)abstract
- The sensitivity to heparin during cardiopulmonary bypass (CPB) is determined by patient-specific characteristics and is assessed by the whole blood activated clotting time (ACT). We aimed to examine reliability measures between two different ACT monitors using Bland-Altman analysis: bias should not exceed 50 ± 50 seconds for measurements performed during CPB or 10 ± 10 seconds before and after CPB. The ACT response should be linear in relation to the concentration of heparin in plasma. Twenty patients (n = 20) aged 20-80 years and admitted for coronary artery bypass surgery were enrolled to this clinical observational study. ACT values and antifactor Xa were sampled: 1) before induction of anesthesia, 2) after heparin bolus, 3) during CPB at the start of rewarming, 4) at weaning from CPB, and 5) after heparin reversal. The evaluation comprised the Hemostasis Management System Plus™ (HMS, Medtronic Inc., Minneapolis, MN) and i-STAT™ (Abbott, Point of Care Inc., Princeton, NJ). Bias for the HMS Plus™ vs. i-STAT™ was +105 ± 119 seconds for measurements during CPB and +2.8 ± 11.7 seconds before and after CPB. Associated limits of agreement for the observed bias were ±235 and ±23 seconds, respectively. Inter-device correlation of ACT values was .46 (p < .001) during CPB; otherwise .48 (p = .02). Both devices produced ACT values unrelated (<10%) to the measured heparin concentration. The use of multivariable regression analysis demonstrated an independent association between the ACT measurement and hematocrit, however, not with the plasma concentration of heparin. ACT monitors demonstrate unacceptable bias differences, combined with wide limits of agreement. The ACT response correlated with hematocrit, but not with the actual heparin concentration.
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| 15. |
- Smulter, Nina, 1972-
(författare)
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Delirium after cardiac surgery : risk factors, assessment methods and costs
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cardiac surgery is considered safe, but postoperative delirium (POD) remains frequently reported. Delirium is characterised by fluctuations in consciousness and cognition, and can be subdivided into disturbed psychomotoric activity (hyperactive and hypoactive) and psychiatric symptom profiles (psychotic and emotional). Delirium has an underlying cause that can be prevented and treated, provided the condition is detected. Undetected delirium could lead to serious consequences for the patient.Aim: This thesis aims to understand the underlying risk factors of delirium, to compare different assessment methods and documentation, and to understand its effects on hospitalisation costs after cardiac surgery.Methods: Two cohorts of patients undergoing cardiac surgery at the Heart Centre, Umeå University Hospital, Sweden were analysed. Cohort-A (Studies I-IV) enrolled 142 patients, ≥70 years of age, scheduled in 2009 for surgery with cardiopulmonary bypass (CPB). POD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th ed, text rev (DSM-IV-TR), based on repetitive assessments with the Mini-Mental State Examination (MMSE) and the Organic Brain Syndrome (OBS) scale. This method was considered as reference. Predisposing and precipitating risk factors were explored (Study I), and a separate analysis was conducted with focus on CPB parameters (Study II). Patients were also assessed for POD with the Confusion Assessment Method (CAM), which was validated versus the reference method (Study III). Additionally in Study IV, data about how nurses assessed patients for POD symptoms using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with information extracted from the clinical database. Moreover, discharge summaries from both nurses and physicians were retrospectively reviewed for key words and expression associated with delirium. Cohort-B (Study V) included 1879 routine cardiac surgery patients (2014-2017) retrospectively extracted from the clinical database with concomitant Nu-DESC scoring. The association between the Nu-DESC and postoperative hospitalization costs was analysed.Results: In cohort-A, 54.9% (78/142) patients developed POD. Both predisposing and precipitating risk factors were significantly associated with POD, of which the ‘volume load during operation’ had the strongest predictive influence (Study I). Among CPB variables the ‘duration of mixed-venous oxygen saturation <75%’ predicted POD (Study II). Hypoactive was more common than hyperactive delirium. Those with hypoactive delirium were less likely to be detected by the CAM method (Study III), an observation also demonstrated from information found in the clinical database and in discharge summaries. Nu-DESC did not detect all patients with POD, but significantly increased the detection rate (Study IV). The major hospitalisation costs associated with Nu-DESC ≥2 occurred in the ICU and independently of the surgical procedure performed. There were no significant differences in costs among patients with Nu-DESC ≥2, between age groups (70-year cut-off) or genders (Study V).Conclusions: Both predisposing and precipitating risk factors contributed to POD and should be considered in future guidelines to prevent delirium after cardiac surgery. Hypoactive delirium was most common, but was the most difficult to detect without screening scales. Systematic assessment with Nu-DESC improved the detection rate of POD. Delirium after cardiac surgery has consequences on healthcare and is associated with increased costs.
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| 16. |
- Smulter, Nina, et al.
(författare)
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Disturbances in Oxygen Balance During Cardiopulmonary Bypass : A Risk Factor for Postoperative Delirium
- 2018
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Saunders Elsevier. - 1053-0770 .- 1532-8422. ; 32:2, s. 684-690
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to determine risk factors for postoperative delirium after cardiac surgery, specifically associated with the conduct of cardiopulmonary bypass (CPB).Design: Prospective observational study.Setting: Heart Centre, University Hospital.Participants: The study included 142 patients aged 70 years and older scheduled for elective cardiac surgery with CPB.Interventions: Risk factor analysis comprised information collected from the hospital clinical and CPB dedicated databases in addition to the medical chart. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criterion using the Mini Mental State Examination and the Organic Brain Syndrome scale.Measurements and Main Results: Assessments of delirium diagnosis were executed preoperatively and on the following first and fourth postoperative days. Delirium occurred in 55% (78/142) of the patients. Patients with delirium were identified with significantly higher body weight and body surface area preoperatively, accompanied with longer CPB time, higher positive fluid balance per CPB, and lower systemic pump flow related to body surface area. Furthermore, the duration of the mixed venous oxygen saturation (SvO2) below 75% was significantly longer during CPB. The result from the multivariable logistic regression analysis included the duration of SvO2 below 75%, fluid balance per CPB and patient age as independent risk factors for postoperative delirium.Conclusions: The influence of the SvO2 level during CPB, fluid balance, and patient age should be recognized as risk factors for postoperative delirium after cardiac surgery in patients 70 years and older.
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| 17. |
- Svenmarker, Staffan, et al.
(författare)
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Clinical effects of the heparin coated surface in cardiopulmonary bypass
- 1997
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press. - 1010-7940 .- 1873-734X. ; 11:5, s. 957-964
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In a randomised study of 120 patients, undergoing primary operation for coronary heart decease, two groups were investigated as regards to the effects of heparin coated cardiopulmonary bypass on brainfunction parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with covalent bonded heparin; the control group (n = 59) used an identical set-up without heparin treatment. Systemic heparin doses were calculated to achieve ACT levels of 250 and 500 s, respectively. Postoperative course was evaluatedby examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain function was assessed by the biochemical marker S-100 and tests of memory performance.RESULTS: There were several signs of reduced operative trauma in the study group. Hospital stay was reduced by nearly 1 day (P < 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was significantly reduced (P = 0.03). Neurological deviations were fewer (P =0.01). Brain function assessment revealed reduced plasma levels of S- 100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P= 0.04). However, no remediation of memory impairment could be demonstrated.CONCLUSIONS: Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively the operative stress to the patient. There were also signs of improved cerebral protection.
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| 18. |
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| 19. |
- Svenmarker, Staffan, et al.
(författare)
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Plasma hyperosmolality during cardiopulmonary bypass is a risk factor for postoperative acute kidney injury : results from double blind randomised controlled trial
- 2024
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Ingår i: Perfusion. - : Sage Publications. - 0267-6591 .- 1477-111X.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The study objective was to investigate whether a Ringer’s acetate based priming solution with addition of Mannitol and sodium concentrate increases the risk of cardiac surgery associated kidney injury (CSA-AKI).Methods: This is a double blind, prospective randomized controlled trial from a single tertiary teaching hospital in Sweden including patients aged ≥65 years (n = 195) admitted for routine cardiac surgery with cardiopulmonary bypass. Patients in the study group received Ringer’s acetate 1000 mL + 400 mL Mannitol (60 g) + sodium chloride 40 mL (160 mmol) and heparin 2 mL (10 000 IU) 966 mOsmol (n = 98), while patients in the control group received Ringer’s acetate 1400 mL + heparin 2 mL (10 000 IU), 388 mOsmol (n = 97) as pump prime. Acute kidney injury was analysed based on the Kidney Disease Improving Outcomes (KDIGO 1-3) definition.Results: The overall incidence of CSA-AKI (KDIGO stage 1) was 2.6% on day 1 in the ICU and 5.6% on day 3, postoperatively. The serum creatinine level did not show any postoperative intergroup differences, when compared to baseline preoperative values. Six patients in the Ringer and five patients in the Mannitol group developed CSA-AKI (KDIGO 1-3), all with glomerular filtration rates <60 mL/min/1.73 m2. These patients showed significantly higher plasma osmolality levels compared to preoperative values. Hyperosmolality together with patient age and the duration of the surgery were independent risk factors for postoperative acute kidney injury (KDIGO 1-3).Conclusions: The use of a hyperosmolar prime solution did not increase the incidence of postoperative CSA-AKI in this study, while high plasma osmolality alone increased the associated risk by 30%. The data suggests further examination of plasma hyperosmolality as a relative risk factor of CSA-AKI.
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| 20. |
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| 21. |
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| 22. |
- Ödling Davidsson, Fredrik, et al.
(författare)
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Reversal of Heparin After Cardiac Surgery : Protamine Titration Using a Statistical Model
- 2015
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1053-0770 .- 1532-8422. ; 29:3, s. 710-714
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To establish a statistical model for determination of protamine dose in conjunction with cardiopulmonary bypass. Design: Prospective.Setting: University hospital.Participants: Ninety consecutive cardiac surgical patients.Interventions: None.Measurements and Main Results: A series of clinically oriented variables were introduced into a statistical model for projection of the protamine dose after cardiopulmonary bypass. The following significant predictors were identified using multivariable regression analysis: The patient's body surface area, the administered dose of heparin, heparin clearance, and the preoperative platelet count. The statistical model projected the protamine dose within 3 +/- 23 mg of the point-of-care test used as reference.Conclusion: Protamine dosing based on statistical modeling represents an alternative to point-of-care tests.
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