Effects of Shed Mediastinal Blood on Cardiovascular and Pulmonary Function: A Randomized, Double-Blind Study
| Autor: | Munir, Boodhwani, Howard J, Nathan, Thierry G, Mesana, Fraser D, Rubens, Rosendo, Rosendo Rodriguez |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Blood Loss Surgical Myocardial Infarction Myocardial Ischemia Hemodynamics Centrifugation Cardiovascular System law.invention Pulmonary function testing Blood Transfusion Autologous Postoperative Complications Double-Blind Method Reference Values Risk Factors law Cardiopulmonary bypass Humans Medicine Hospital Mortality Coronary Artery Bypass Aged Probability Cardiopulmonary Bypass business.industry Venous blood Middle Aged Respiratory Function Tests Cardiac surgery Survival Rate medicine.anatomical_structure Anesthesia Multivariate Analysis Linear Models Vascular resistance Female Vascular Resistance Surgery Cardiology and Cardiovascular Medicine business Cardiotomy Follow-Up Studies Artery |
| Zdroj: | The Annals of Thoracic Surgery. 86:1167-1173 |
| ISSN: | 0003-4975 |
| Popis: | Shed mediastinal blood during cardiopulmonary bypass (cardiotomy blood) contains fat, particulate matter, and vasoactive mediators that can adversely affect the pulmonary and systemic vasculature, as well as impair gas exchange. Our aim was to evaluate the effects of processing cardiotomy blood on cardiovascular and pulmonary function after cardiac surgery.Patients undergoing coronary artery bypass or aortic valve surgery, or both, using cardiopulmonary bypass were randomly allocated to receiving processed (treated, n = 132) or unprocessed shed blood (control, n = 134) In the treated group, shed blood was processed by centrifugation, washing, and additional filtration. Pulmonary function, arterial and venous blood gases, and hemodynamics were measured before, immediately after, and 2 hours after cardiopulmonary bypass in a consecutive subset of patients (n = 154). Patients and treating physicians were blinded to treatment assignment.Preoperative characteristics were similar between groups. There were no significant differences between groups in indexes of pulmonary mechanical function at any of the measured time points. Patients in the treated group demonstrated reduced pulmonary and systemic vascular resistance (both p0.01) as well as increased cardiac index in the perioperative period (2.6 +/- 0.07 versus 2.3 +/- 0.06 L . min(-1) . m(-2) at 2 hours after CPB, p = 0.004). Larger volumes of cardiotomy blood were associated with greater changes in systemic and pulmonary vascular resistance. Indicators of pulmonary gas exchange were similar between groups at all measured time points. Treated patients demonstrated a trend toward reduced length of ventilation (11.0 +/- 1.9 versus 13.9 +/- 2.4 hours, p = 0.12).Processing of shed mediastinal blood improves cardiopulmonary hemodynamics and may reduce ventilatory requirements after cardiac surgery. |
| Databáze: | OpenAIRE |
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