Factors associated with red blood cells transfusion during first bloodless priming cardiac surgery in children.

INTRODUCTION: Red blood cell (RBC) transfusion is often required during cardiac surgery in children. However, RBC is a rare product, and its transfusion is associated with adverse events and a worse surgical outcome. Characterization of factors related to RBC transfusion during cardiac surgery in children would provide prevention strategies. METHODS: We conducted a retrospective single-center study, including all children who underwent their first cardiac surgery using bloodless priming cardiopulmonary bypass (CPB). RESULTS: The study included 173 children between 2011 and 2019,; 57 had intraoperative transfusion and 17 postoperative transfusion. Age (OR: 0.76, p<0.001), weight (OR: 0.93, p<0.001), body mass index ([BMI] OR: 0.83, p<0.001), hemoglobin level (OR: 0.68, p<0.05), hematocrit level (OR: 0.88, p<0.05), mean corpuscular volume ([MCV] (OR: 0.86, p<0.001), hemodilution (OR: 100, p<0.01), and CPB duration (OR: 1.01, p<0.05) were associated with an increased risk of intraoperative transfusion in univariate analysis. In multivariate analysis, only CPB duration (OR: 1.02, p<0.001) and MCV (OR: 0.89, p<0.05) were associated with transfusion. Concerning postoperative transfusions, the RACHS surgical difficulty score (OR: 6.83, p<0.01), duration of CPB (OR: 1.01, p<0,001), length of stay in the PICU (OR: 2.37, p<0.001), length of hospitalization (OR: 1.2, p<0.001), and reoperation (OR: 20.59, p<0.001) were significant using univariate analysis, and only the need for a reoperation (OR: 19.16, p<0.01) remained significant in multivariate analysis. CONCLUSION: Low MCV appears to be one of the main risk factors for intraoperative transfusion in RBC. It may reflect iron deficiency that should be checked and supplemented preoperatively in order to reduce the risk of transfusion.

The oxygenation variations related to prone positioning during mechanical ventilation: a clinical comparison between ARDS and non-ARDS hypoxemic patients.

OBJECTIVES: To compare, in clinical practice, the oxygenation variations related to prone positioning (PP) during mechanical ventilation in ARDS and non-ARDS hypoxemic patients. DESIGN AND SETTING: Prospective observational study of data on consecutive patients treated with the same protocol in the intensive care unit (ICU) of a university hospital. PATIENTS: From May 1996 to December 1998, 226 PP periods without adjunction of nitric oxide (NO) inhalation and/or almitrine bismesylate infusion, performed in 59 mechanically ventilated hypoxemic patients (arterial oxygen tension/fractional inspired oxygen (PaO2/FIO2) ratio <300 mmHg) with no evidence of left ventricular failure, were included in this study. MEASUREMENTS: Arterial blood gas was measured before the PP, at 1 h from the beginning of the PP, at the end of the PP and 1 h after returning to the supine position. RESULTS: We analyzed 136 PP periods in 34 non-ARDS patients (60.2%) and 90 in 25 ARDS patients. The PP was repeated and the duration of the PP periods was: 10.6+/-0.22 h. The PP during the mechanical ventilation appeared to be safe and well tolerated. A PaO2/FIO2 ratio improvement at the end of the PP period, occurred for 196 periods (86.7%) with a mean PaO2/FIO2 ratio increase of +46.4+/-0.03% at the end of the PP periods compared to the baseline supine value. The PaO2/FIO2 ratio variations at 1 h after the start of the PP, at the end of the PP period and at 1 h after the return to supine were not different in ARDS or non-ARDS hypoxemic patients. The PaO2/FIO2 ratio improvement appeared to be more intense and more rapid in ARDS patients. CONCLUSIONS: In about 90% of periods, PP improved the PaO2/FIO2 ratio in patients with ARDS as well as in hypoxemic patients with non-ARDS. Studies are necessary to determine the impact of PP on survival and the mechanical ventilation duration in ARDS or non-ARDS hypoxemic patients.

Use of Salmonella typhimurium TA 98, YG 1024 and YG 1021 and deconjugating enzymes for evaluating the mutagenicity from smokers' urine.

Four smokers were chosen for their different smoking habits, and their declared cigarette consumption confirmed by urinary measurement of nicotine and its metabolites. The promutagenicity of their urine was evaluated by the Ames test, modified according to Kado et al. (Mutation Res., 31 (1983)25-32) after extraction on XAD2 Amberlite resin. The different Salmonella typhimurium strains TA 98, YG 1021 and YG 1024 were compared to determine the presence of amino aromatic compounds in the urine of smokers of blond and black tobacco. The strain YG 1024 shows higher mutagenicity than TA 98 for extracts from the smoker's urine and more particularly from black tobacco smokers. In addition, the pretreatment of urine by external enzymatic systems (beta-glucuronidase or arylsulfatase) reveals the presence in the urine of glucurono- and sulfoconjugated forms of promutagens, including amino aromatic compounds.

Urinary promutagens of smokers: comparison of concentration methods and relation to cigarette consumption.

Different extraction techniques can be used to concentrate the promutagens of cigarette smokers' urine before evaluation of their mutagenic potency by Ames test. In this study, three solid adsorbents, C18, XAD2 and CN were compared for their ability to concentrate the promutagens of smokers' urine prior to acetone elution. C18 extracts were observed to have a higher promutagenicity than XAD2 and CN extracts. The mutagenicity of smokers' urine depended on the smoking habits, and a strong correlation was observed between urinary promutagenicity, daily cigarette consumption, and the tobacco type (black or blond). Smokers of black tobacco had a higher urinary genotoxicity than smokers of blond tobacco, after taking into account the level of tobacco consumption. Urinary promutagenicity did not appear to depend on the tar level of cigarettes.