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- Blomquist, Sten, et al.
(författare)
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Lung mechanics, gas exchange and central circulation during treatment of intra-abdominal hemorrhage with pneumatic anti-shock garment and intra-aortic balloon occlusion. An experimental study in pigs
- 1994
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Ingår i: European Surgical Research. - : S. Karger AG. - 0014-312X .- 1421-9921. ; 26:4, s. 240-247
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Tidskriftsartikel (refereegranskat)abstract
- Standardized intra-abdominal hemorrhage was induced in 7 anesthetized pigs. The resulting hypovolemic shock was treated with pneumatic anti-shock garment (PASG) followed by intra-aortic balloon occlusion. The effects of this treatment on circulation, lung mechanics and gas exchange were studied. Hemorrhage was induced by pulling out sutures introduced in the inferior caval vein. We found that the use of PASG partially restored mean arterial blood pressure from 44 +/- 6 to 66 +/- 6 mm Hg. When intraaortic balloon occlusion was added, the arterial pressure returned to basal levels. Cardiac output fell severely due to the hemorrhage from 3.7 +/- 0.2 to 1.3 +/- 0.2 liters/min and could not be restored during the treatment. A severe fall in total lung compliance was recorded after inflation of the PASG from 18.6 +/- 0.9 to 10 +/- 0.7 ml/cm H2O, this was accompanied by a fall in alveolar ventilation. These findings emphasize the severe restriction in lung function that occurred during treatment with PASG. Both parameters returned to near normal values when the PASG was deflated and the intra-aortic balloon was inflated. Pulmonary vascular resistance increased by more than 400% and remained high during the study period. There was no change in arterial PO2, however the fall in mixed venous PO2 caused by hemorrhage was reversed at the end of the treatment. Indirect monitoring of cerebral function by continuous EEG showed a decreased voltage during the hemorrhage, this was reversed by the combined treatment. We conclude that the outlined treatment makes it possible to restore central hemodynamics and preserve cerebral function at least for a short period of time until definite surgical treatment can be performed. However, severe restriction on lung mechanics, especially when PASG was inflated, makes it probable that ventilatory support can be necessary in such cases.
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- Bolys, Ramunas, et al.
(författare)
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Vascular function in the cadaver up to six hours after cardiac arrest
- 1999
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Ingår i: The Journal of Heart and Lung Transplantation. - 1557-3117. ; 18:6, s. 582-586
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to evaluate how well vascular function is retained in a cadaver kept in a room with a temperature of 21 degrees C. METHODS: The aorta and pulmonary artery of rats were investigated in organ baths as fresh controls and after 1, 2, 3, or 6 hours' storage in the cadaver. Six-hour-old cadaver aortas were transplanted and investigated after 24 hours and 60 days. RESULTS: After 3 hours' storage there was no significant decrease in smooth muscle contractile function in either aorta or pulmonary artery. After 6 hours' storage both the aorta and the pulmonary artery demonstrated a significant decrease in smooth muscle contractile function, 30% (p < 0.05) and 44% (p < 0.001), respectively, compared to fresh controls. Storing the aorta for 2 hours and the pulmonary artery for 6 hours caused no significant decrease in endothelium-dependent relaxing function. In aorta segments investigated after 3 and 6 hours there was a significant decrease in endothelium-dependent relaxation, 12% (p < 0.05) and 29% (p < 0.001), respectively. Six-hour-old cadaver aortas transplanted and investigated after 24 hours or 60 days demonstrated no significant changes in endothelium-dependent relaxation and smooth muscle function compared to fresh controls. CONCLUSION: The pulmonary artery can tolerate 3 hours of warm ischemia in the nonheart-beating cadaver without loss of endothelium-dependent relaxation and smooth muscle function. The dysfunction seen in 6-hour-old cadaver aortas was normalized after transplantation and 24 hours of reperfusion.
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- Budrikis, Algimantas, et al.
(författare)
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Effects of cardioplegic flushing, storage, and reperfusion on coronary circulation in the pig
- 1999
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Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 67:5, s. 1345-1349
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to investigate how flush-perfusion of the heart with cold cardioplegic solution, 2 or 12 hours of cold ischemic storage, and 24 hours of reperfusion affect coronary endothelial function and coronary vascular resistance. METHODS: Porcine coronary arterial endothelial and smooth muscle function was studied in organ baths. An adult porcine working heart model was used to investigate coronary vascular resistance after 24 hours of reperfusion. RESULTS: Flushing the heart with 1 L of St. Thomas' cardioplegic solution, using a perfusion pressure of 60 to 65 mm Hg, significantly reduced endothelium-dependent relaxation. Flushing followed by 12 hours of storage gravely impaired endothelium-dependent relaxation, and 24 hours of reperfusion worsened it still more. CONCLUSIONS: Flushing the heart with cold cardioplegic solution impairs endothelium-dependent relaxation, as does prolonged cold ischemic storage. Reperfusion of injured coronary endothelium may injure it still more. A correlation was found (p < 0.001) between high coronary vascular resistance and low endothelium-dependent relaxation.
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| 7. |
- Budrikis, A, et al.
(författare)
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Function of adult pig hearts after 2 and 12 hours of cold cardioplegic preservation
- 1998
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Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 66:1, s. 73-78
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Most cardioplegic solutions have been developed using the classic Langendorf heart perfusion model, which only allows a short experimental follow-up. Our aim was to investigate hearts after prolonged storage by using a physiologic model including prolonged perfusion with normal, fresh blood. METHODS: Sixteen hearts from 60-kg pigs were preserved with dextran-enriched (dextran-40, 35 g/L) St. Thomas' solution for 2 or 12 hours after which they were continuously reperfused for 12 hours with normal blood, supplied by a support pig. A flexible balloon, fixed to an artificial valve apparatus connected to a circuit system, was inserted in the left ventricle for obtaining measurements of hemodynamic performance. RESULTS: During the first 3 to 4 hours of reperfusion there was no significant difference in left ventricular developed pressure, cardiac output, minute work output, or oxygen consumption between the two groups. After this time left ventricular developed pressure (p < 0.001), cardiac output (p < 0.01), minute work output (p < 0.01), and oxygen consumption were significantly lower in the 12-hour group. Coronary flow was higher (p < 0.01) and coronary vascular resistance lower (p < 0.01) during the first 5 to 6 hours of reperfusion in the 12-hour group. After 12 hours of reperfusion coronary vascular resistance was significantly higher (p < 0.01) in the 12-hour group. CONCLUSIONS: High-degree and long-lasting coronary hyperemia at the beginning of reperfusion can be a sign of unsatisfactory preservation of the heart. This investigation shows the importance of reperfusion with normal blood and a long follow-up period after postischemic reperfusion when studying the effect of cardioplegic solutions.
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- Eriksson, Leif, et al.
(författare)
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Cardiovascular effects of induced hypothermia after lung transplantation
- 1999
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Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 67:3, s. 804-809
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Induced hypothermia may be used to reduce metabolism in acute respiratory failure. Hypothermia is accompanied by an increase in pulmonary vascular resistance, as also seen in the early period after lung transplantation. It was our concern that the combination of the two would lead to an increased workload on the right ventricle. METHODS: To test this hypothesis we induced hypothermia to 32 degrees C in two groups of pigs. In one group we performed left single-lung transplantation combined with right pulmectomy (TRANSP group); in the other group, only right pulmectomy was performed (PULMEC group). RESULTS: During hypothermia, there was a significant increase in both groups in pulmonary vascular resistance (TRANSP group, 77%, p<0.05; PULMEC group, 54%, p<0.05) and a significant decrease in cardiac output (TRANSP group, 41%, p<0.05; PULMEC group, 34% p<0.05). Mean pulmonary artery pressure was unchanged, and the work done by the right ventricle was reduced (TRANSP group, 39%, p<0.05; PULMEC group, 31%). CONCLUSIONS: Induced hypothermia to 32 degrees C after lung transplantation resulted in a significant decrease in the work done by the right ventricle despite a significant increase in pulmonary vascular resistance.
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| 9. |
- Eriksson, Leif, et al.
(författare)
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Induced hypothermia in critical respiratory failure after lung transplantation
- 1998
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Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 65:3, s. 827-829
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Tidskriftsartikel (refereegranskat)abstract
- Primary graft failure after lung transplantation is a serious complication with high mortality. We present 2 cases of critical respiratory failure after lung transplantation treated with surface cooling to 32 degrees and 35 degrees C, respectively, as an adjunct to conventional intensive care. Both patients were discharged from the hospital in good clinical condition. Surface cooling may be an effective mode of treatment in patients with critical respiratory failure after lung transplantation and should be considered before extracorporeal membrane oxygenation treatment is initiated.
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| 10. |
- Eriksson, Leif, et al.
(författare)
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Lung transplantation at the University of Lund 1990-1995. Analysis of the first 39 consecutive patients
- 1998
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 32:1, s. 23-28
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Tidskriftsartikel (refereegranskat)abstract
- Between 1990 and 1995 39 patients were lung transplanted at the University Hospital in Lund. This is a retrospective review of survival and lung function in these patients. There were 17 single-lung transplants (SLT), 21 double-lung transplants (DLT) and 1 heart-lung transplant (HLT). Seven patients died during the period, giving an overall survival of 82%. One-year survival according to Kaplan-Meier survival analysis was 87%, and 2-year survival was 83%. Vital capacity and forced expiratory volume in 1 s (FEV1) 1 year after transplantation were 91% and 100% of predicted, respectively, in the DLT group and 60% and 50% in the SLT group. Bronchiolitis obliterans syndrome (BOS) developed in 11 of the 35 patients (31%) surviving more than 6 months, 2/21 in the DLT group and 8/13 in the SLT group and in the patient with HLT. The median time until detection of BOS was 11 months after the operation (range 6-18 months). Working capacity 1 year after transplantation was 60% of predicted in the DLT group and 47% of predicted in the SLT group. Ventilatory capacity was no longer function limiting. Lung transplantation today is a therapeutic option with a good medium-term survival and good functional results in selected patients with severe lung disease.
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