Regional Perfusion Abnormalities With Phenylephrine During Normothermic Bypass

O’Dwyer, Catherine; Woodson, Lee C.; Conroy, B.; Chen, Lin; Deyo, Donald J.; Uchida, Tatsuo; Johnston, William

doi:10.1016/s0003-4975(96)01116-2

Cited by 98 publications

(58 citation statements)

References 15 publications

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“…Treatment with nonsteroidal anti-inflammatory drugs has been shown to cause gastric ischemia through their inhibitory action on vasodilating prostaglandin production [2]. Gastric ischemia has also been observed during and after CPB [5,6]; thus, a common pathogenetic mechanism can be hypothesized. Impairment of the microcirculation during CPB has been found in different organs, such as the pancreas, kidney and small bowel [5,7].…”

Section: Introductionmentioning

confidence: 99%

“…Gastric ischemia has also been observed during and after CPB [5,6]; thus, a common pathogenetic mechanism can be hypothesized. Impairment of the microcirculation during CPB has been found in different organs, such as the pancreas, kidney and small bowel [5,7]. The underlying mechanisms are discussed controversially and are not fully understood [8].…”

Section: Introductionmentioning

confidence: 99%

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Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Bomberg

Bierbach²,

Flache³

et al. 2014

Eur Surg Res

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Background/Aim: Upper gastrointestinal bleeding (UGIB) is one of the most frequent gastrointestinal complications after cardiac surgery with cardiopulmonary bypass (CPB). Endothelin expression and microcirculatory dysfunction have been shown to be involved in UGIB. The aim of this study was to analyze the effect of vasopressin during CPB on the gastric mucosal microcirculation and the involvement of the endothelin system. Methods: Eighteen pigs were randomized into three groups (n = 6 each): group I = sham, group II = CPB (1-hour CPB) and group III = CPB + vasopressin (1-hour CPB and vasopressin administration during CPB to maintain baseline arterial pressure). All animals were observed for a further 90 min after termination of CPB. Systemic hemodynamics as well as blood flow and oxygen saturation of the gastric mucosa were measured continuously. At the end of the experiment, the gastric mucosal expressions of endothelin-1 (ET-1) and its receptor subtypes A (ET_A) and B (ET_B) were determined by polymerase chain reaction. Gastric mucosal injury, apoptotic cell death and leukocytic infiltration were determined by histology and immunohistochemical analyses of cleaved caspase-3 and myeloperoxidase. Results: CPB decreased gastric microvascular perfusion, which was associated with an increased expression of ET-1 and ET_A. Vasopressin aggravated the CPB-associated malperfusion, whereas it completely abrogated the upregulation of ET-1 and ET_A. Interestingly, vasopressin did not induce gastric mucosal morphologic injury, leukocytic infiltration or apoptotic cell death. Conclusion: Vasopressin aggravates CPB-associated microvascular malperfusion of the gastric mucosa but does not induce gastric mucosal injury.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Bomberg

Bierbach²,

Flache³

et al. 2014

Eur Surg Res

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“…In a swine model study [31], reductions in pump flow did not affect cerebral blood flow, but significantly reduced perfusion of all visceral organs. Increasing the pump flow restored perfusion to other organs, whereas restoration of systemic pressures with phenylepherine did not.…”

Section: Blood Flowmentioning

confidence: 87%

Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers

García

Krane

Baumgartner

et al. 2014

Medical Engineering & Physics

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ZusammenfassungDie frühe Behandlung mit Extrakorporalen Kreislauf-Unterstützungssystemen bei Patienten mit kardiogenem Schock wirkt sich positiv auf den weiteren Verlauf aus und kann einem Multi-Organversagen entgegenwirken. Um eine frühe Behandlung zu ermöglichen, ist eine kontinuierlicheÜberwachung des Patienten durch geschulte Kardiotechniker notwendig. Unter Notfallbedingungen kann eine ungeteilte Aufmerksamkeit für den Patienten nicht garantiert werden womit es zu Behandlungsfehlern kommen kann.Durch AbstractPatients suffering from cardiogenic shock may benefit with an early application of a portable Extracorporeal Circulatory Support System (ECSS) preventing multi organ failure. This however requires the presence and constant supervision of the patient by trained personal at the emergency site. Under these circumstances full attention to the patient may not be guaranteed and operation errors may occur.With the automation of the portable ECSS optimal perfusion may be achieved with minimal workload for the human operator allowing the safe transportation of the patient to the hospital.The focus of this thesis is the development of an adaptive and robust control system that regulates perfusion based on online data of the patient. While the system needs to be highly dynamic, so that it is able to adapt to different situations, it must ensure maximal patient safety at all times.To develop such control system first an animal model was used to analyze the type of signals acquired during extracorporeal circulation. This information was used as a reference for the creation of a mathematical model. The model includes a cardiovascular system undergoing extracorporeal circulation, a gas exchange model and a medication model. This was integrated into a simulation system that could be used for the creation and evaluation of the designed controller.Fuzzy logic was considered as a control mechanism allowing the easy creation of rules based on the knowledge of trained perfusionists. Since patient pre-conditions and reactions will be different from one case to another an adaptive mechanism is proposed to modify the existing controller and adapt to the specific needs of the patient.A software framework was developed allowing a fast implementation of the control system. This framework was created not only focusing on the automation of the ECSS but also to serve as a basis for the development of control systems for other medical devices with similar requirements.Several simulations are presented showing the performance of the fuzzy controller with the proposed adaptive mechanism. Additional simulations show the response of the designed ECSS controller under different patient scenarios.vii Acknowledgments I want to give thanks to my advisor Prof. Dr. Alois Knoll for giving me the opportunity of working in this thesis, for his support and confidence. I would also like to thank Prof. Dr. Robert Bauernschmitt for taking the time to review my work and acting as a second advisor. From the department of Robotics and Embedded Systems ...

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“…The Forty-eight hour postoperative AST and AST/ALT ratio were lower in off-pump group, and ALT levels were similar in both groups. In patients undergoing on-pump coronary surgery, possible factors causing liver dysfunction may be the decrease in systemic vascular resistance, low CPB pressure, inflammatory activation and microemboluses (14,15). Fifty percent of patients undergoing CABG was shown to have temporary intestinal mucosal ischemia indicated by intramucosal acidosis.…”

Section: Discussionmentioning

confidence: 99%

On-Pump Cardiopulmonary Bypass Versus Off-Pump Coronary Artery Bypass Grafting Surgery: Renal And Liver Function Tests

Bayram

Zor

Erer

et al. 2016

GMJ

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Objective: Cardiopulmonary bypass (CPB) triggers systemic inflammation. Inflammatory system activation may cause deteoriation in liver and renal functions. In our study we aimed to search the effect of on-pump CPB and beating heart off-pump coronary artery bypass grafting (CABG) surgery techniques on renal and liver functions. Methods: Sixty four patients who underwent coronary artery surgery were included in the study and were divided into two groups: on-pump CPB group (40) and beating heart off-pump CABG group (24), prospectively. The blood samples were collected for preoperative and postoperative levels of blood urea nitrogen (BUN), creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and AST to ALT ratio at 24 th and 48 th hours. Results: Clinical and demographic features were similar in both groups. There were no statistically significant difference in levels of preoperative BUN, creatinine, AST, ALT, AST to ALT ratio. The postoperative 24 th hour plasma levels of creatinine, AST and AST/ALT were lower in beating heart off-pump CABG group but BUN and ALT levels were similar among the two groups. The postoperative 48 th hour plasma levels of BUN, creatinine, AST and AST/ALT were lower in beating heart off-pump CABG group but levels of ALT were similar in both groups. Conclusion: Based on our findings we conclude that beating heart off-pump CABG has lower negative effect on liver and renal function than on-pump CPB. Abstract of this manuscript was presented in 7th Congress of Update in Cardiology and Cardiovascular Surgery in association with TCT Mediterranean as a poster.Key Words: Acute kidney injury, cardiopulmonary bypass, coronary artery bypass, coronary artery bypass, off-pump, liver. Anahtar Sözcükler: Akut böbrek hasarı, kardiyopulmoner bypass, koroner arter bypass, off-pump koroner arter bypass graftleme, karaciğer. ReceivedGeliş Tarihi:

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Regional Perfusion Abnormalities With Phenylephrine During Normothermic Bypass

Cited by 98 publications

References 15 publications

Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Vasopressin Aggravates Cardiopulmonary Bypass-Induced Gastric Mucosal Ischemia

Automation of a portable extracorporeal circulatory support system with adaptive fuzzy controllers

On-Pump Cardiopulmonary Bypass Versus Off-Pump Coronary Artery Bypass Grafting Surgery: Renal And Liver Function Tests

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