Comparison of the effectiveness and safety of a new de-airing technique with a standardized carbon dioxide insufflation technique in open left heart surgery: a randomized clinical trial
| Autor: | Sten Blomquist, Faleh Al-Rashidi, Peter Höglund, Per-Axel Karlsson, Bansi Koul, Maya Landenhed, Leif Pierre |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Time Factors Ultrasonography Doppler Transcranial Cost-Benefit Analysis Severity of Illness Index pCO2 law.invention law Monitoring Intraoperative medicine Cardiopulmonary bypass Embolism Air Humans Prospective Studies Registries Cardiac Surgical Procedures Hospital Costs Oxygenator Aged Sweden Cardiopulmonary Bypass business.industry Insufflation Carbon Dioxide Middle Aged medicine.disease Transcranial Doppler Cardiac surgery Surgery Treatment Outcome Embolism Anesthesia Aortic Valve Circulatory system Female Blood Gas Analysis Cardiology and Cardiovascular Medicine business Complication Echocardiography Transesophageal |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 141(5) |
| ISSN: | 1097-685X |
| Popis: | OBJECTIVE: We have compared the effectiveness, time required for de-airing, and safety of a newly developed de-airing technique for open left heart surgery (Lund technique) with a standardized carbon dioxide insufflation technique. METHODS: Twenty patients undergoing elective open aortic valve surgery were randomized prospectively to the Lund technique (Lund group, n = 10) or the carbon dioxide insufflation technique (carbon dioxide group, n = 10). Both groups were monitored intraoperatively during de-airing and for 10 minutes after weaning from cardiopulmonary bypass by transesophageal echocardiography and online transcranial Doppler for the severity and the number of gas emboli, respectively. The systemic arterial partial pressure of carbon dioxide and pH were also monitored in both groups before, during, and after cardiopulmonary bypass. RESULTS: The severity of gas emboli observed on transesophageal echocardiography and the number of microembolic signals recorded by transcranial Doppler were significantly lower in the Lund group during the de-airing procedure (P = .00634) and in the first 10 minutes after weaning from cardiopulmonary bypass (P = .000377). Furthermore, the de-airing time was significantly shorter in the Lund group (9 vs 15 minutes, P = .001). The arterial pH during the cooling phase of cardiopulmonary bypass was significantly lower in the carbon dioxide group (P = .00351), corresponding to significantly higher arterial partial pressure of carbon dioxide (P = .005196) despite significantly higher gas flows (P = .0398) in the oxygenator throughout the entire period of cardiopulmonary bypass. CONCLUSIONS: The Lund de-airing technique is safer, simpler, and more effective compared with the carbon dioxide insufflation technique. The technique is also more cost-effective because the de-airing time is shorter and no extra expenses are incurred. (Less) |
| Databáze: | OpenAIRE |
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