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1.
Perfusion ; 37(2): 144-151, 2022 Mar.
Article in English | MEDLINE | ID: mdl-33570010

ABSTRACT

INTRODUCTION: Arterial filter is the part of the cardiopulmonary bypass circuit where blood cells are exposed to high mechanical stress and where cellular aggregates may fasten in large quantities. The aim of this study was to analyse blood cell adhesiveness in the arterial filter through scanning electron microscopy and real-time PCR assay. METHODS: Prospective, clinical and observational study performed on 28 patients undergoing cardiac surgery with cardiopulmonary bypass. Arterial filters were analysed by scanning electron microscopy. Real-time PCR assay was performed in extracted material from the arterial filters for analysis of platelet GPIb and CD45 leucocyte gene expression. Blood coagulation was analysed during cardiopulmonary bypass. Patients were followed until hospital discharge or 28 days after surgery. RESULTS: All studied arterial filters used in the subject patients showed a degree of adhesion from blood elements at scanning electron microscopy. All studied filters were positive for platelets GPIb gene expression and 15% had CD45 leucocyte gene expression. The GPIb platelet gene expression in blood lowered at the end of cardiopulmonary bypass (p = 0.019). There was negative correlation between blood GPIb platelet gene expression and Clot SR (HEPSCREEN2 ReoRox®) (rho = 0.635; p = 0.027). The filter fields count was correlated to the D-dimer dosage (rho = 0.828; p < 0.001). CONCLUSION: There was adhesion of blood elements, especially nucleated platelets, on all arterial filters studied. Although the arterial filter worked as a safety device, that possibly prevented arterial embolisation, it may also have caused greater hyperfibrinolysis during cardiopulmonary bypass.


Subject(s)
Cardiac Surgical Procedures , Cardiopulmonary Bypass , Blood Cells , Cardiac Surgical Procedures/adverse effects , Cell Adhesion , Humans , Microscopy, Electron, Scanning , Prospective Studies , Real-Time Polymerase Chain Reaction
2.
Anesthesiology ; 126(1): 85-93, 2017 01.
Article in English | MEDLINE | ID: mdl-27841822

ABSTRACT

BACKGROUND: Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome. METHODS: This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l · min · m) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 µg/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days. RESULTS: A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction. CONCLUSIONS: The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.


Subject(s)
Cardiac Surgical Procedures , Norepinephrine/pharmacology , Postoperative Complications/drug therapy , Shock/drug therapy , Vasoplegia/drug therapy , Vasopressins/pharmacology , Brazil , Double-Blind Method , Female , Humans , Male , Middle Aged , Prospective Studies , Shock/complications , Treatment Outcome , Vasoconstrictor Agents/pharmacology , Vasoplegia/complications
3.
Clinics (Sao Paulo) ; 64(1): 51-60, 2009.
Article in English | MEDLINE | ID: mdl-19142552

ABSTRACT

BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant. RESULTS: The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05). CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.


Subject(s)
Blood Glucose/metabolism , Cardiac Surgical Procedures , Cardiopulmonary Bypass , Cardiovascular Diseases/blood , Perioperative Care , Cardiovascular Diseases/surgery , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , Prospective Studies , Treatment Outcome
4.
Clinics ; 64(1): 51-60, 2009. graf, tab
Article in English | LILACS | ID: lil-501888

ABSTRACT

BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant. RESULTS: The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05). CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily...


Subject(s)
Female , Humans , Male , Middle Aged , Blood Glucose/metabolism , Cardiac Surgical Procedures , Cardiopulmonary Bypass , Cardiovascular Diseases/blood , Perioperative Care , Cardiovascular Diseases/surgery , Monitoring, Physiologic , Prospective Studies , Treatment Outcome
5.
Arq Bras Cardiol ; 83(1): 27-34; 18-26, 2004 Jul.
Article in English, Portuguese | MEDLINE | ID: mdl-15322665

ABSTRACT

OBJECTIVE: To assess the care provided to patients with congenital heart diseases and ischemic heart diseases undergoing cardiac surgery according to the fast-track recovery protocol compared with those undergoing the conventional procedure. METHODS: The transfer of patients from one hospital unit to another was assessed for 175 patients, 107 (61%) men and 68 (39%) women, with ages ranging from 0.3 to 81 years. RESULTS: The discharge rate from the different hospital units per unit of time of the patients with congenital heart diseases treated according to the fast-track recovery protocol compared with that of patients conventionally treated was as follows: a) 11.3 times faster than the discharge rate of patients treated according to the conventional protocol, in regard to the time spent in the operating room; b) 6.3 times faster in regard to the duration of the surgical intervention; c) 6.8 times faster in regard to the duration of anesthesia; d) 1.5 times faster in regard to the duration of perfusion; e) 2.8 times faster in regard to the stay in the postoperative recovery I unit; f) 6.7 times faster in regard to hospital stay (time period between hospital admission and hospital discharge); g) 2.8 times faster in regard to the stay in the preoperative unit; h) 2.1 times faster in regard to the stay in the admission unit after discharge from postoperative recovery; i) associated with reduced costs. The difference was not significant for patients with ischemic heart disease. CONCLUSION: A reduction in the length of hospital stay and costs for the care of patients undergoing cardiac surgery according to the fast-track protocol was observed.


Subject(s)
Heart Defects, Congenital/surgery , Length of Stay/statistics & numerical data , Myocardial Ischemia/surgery , Postoperative Care/economics , Recovery Room/economics , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Clinical Protocols , Female , Humans , Infant , Male , Middle Aged , Patient Transfer , Postoperative Complications , Risk , Treatment Outcome
6.
Arq. bras. cardiol ; 83(1): 18-34, jul. 2004. tab, graf
Article in English, Portuguese | LILACS | ID: lil-363841

ABSTRACT

OBJETIVO: Avaliar o atendimento de cardiopatas congênitos e cardiopatas isquêmicos submetidos à cirurgia cardíaca no protocolo de atendimento na via rápida (fast-track recovery) em relação ao convencional. MÉTODOS: Avaliada a movimentação de 175 pacientes, 107 (61 por cento) homens e 68 (39 por cento) mulheres, idades entre 0,3-81 anos nas diferentes unidades hospitalares. RESULTADOS: A taxa de alta das diferentes unidades hospitalares por unidade de tempo, dos cardiopatas congênitos atendidos no protocolo da via rápida em relação ao convencional foi: a) 11,3 vezes a taxa de alta quando assistidos no protocolo da via convencional, quanto ao tempo de permanência no centro cirúrgico; b) 6,3 vezes quanto à duração da intervenção cirúrgica; c) 6,8 vezes quanto à duração da anestesia; d) 1,5 vezes quanto à duração da perfusão; e) 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f) 6,7 vezes quanto à permanência no hospital (período de tempo entre a data da internação e a data da alta); g) 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h) 2,1 vezes quanto à permanência na unidade de internação após a alta da recuperação pós-operatória; i) associada com redução de despesas pré e pós-operatórias. A diferença não foi significativa nos portadores de cardiopatia isquêmica. CONCLUSAO: Verificou-se redução do período de internação e de despesas no atendimento dos pacientes submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Heart Defects, Congenital/surgery , Length of Stay/statistics & numerical data , Myocardial Ischemia/surgery , Postoperative Care/economics , Recovery Room/economics , Clinical Protocols , Postoperative Complications , Risk , Treatment Outcome
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