Ultrafiltration of the Priming Blood Before Cardiopulmonary Bypass Attenuates Inflammatory Response and Improves Postoperative Clinical Course in Pediatric Patients

Shimpo, Hideto; Shimamoto, Akira; Sawamura, Yutaka; Fujinaga, Kazuya; Kanemitsu, Shinji; Onoda, Koji; Takao, Motoshi; Mitani, Yoshihide; Yada, Isao

doi:10.1097/00024382-200116001-00010

Cited by 36 publications

(19 citation statements)

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“…Both these techniques simply result in hemodilution of metabolites with some improvement in the electrolyte and acid-base balance. In sharp contrast to our results, Shimpo et al (9) in their clinical study found significantly lower cytokine production, better water balance, low inotrope requirement, and shorter duration of ventilation and intensive care unit stay with use of UF. However, the technique of UF used by Shimpo et al was actually HF rather than conventional UF (11).…”

Section: Discussioncontrasting

confidence: 99%

Hemodiafiltration—A Technique for Physiological Correction of Priming Solution in Pediatric Cardiac Surgery: An In Vitro Study

et al. 2016

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Pediatric cardiopulmonary bypass (CPB) circuit invariably requires priming with packed red blood cells (PRBCs). Metabolic composition of stored PRBCs is unphysiological and becomes worse with increasing duration of storage. It is recommended to correct these abnormalities before initiation of CPB. We tested the hypothesis that hemodiafiltration of the prime with 0.45% saline is sufficient for reducing the metabolic load and reaching a physiologic state. In an in vitro study, 100 mL of blood each from 45 units of PRBCs stored for 3–20 days were used for priming the 45 neonatal CPB circuits. Based upon the method used for removal of excess crystalloid from the prime, circuits were divided into three groups. Group 1: Direct removal through manifold line. Group 2: Ultrafiltration of prime. Group 3: Hemodiafiltration of the prime. Blood gas analyses were obtained from the PRBCs and from the prime before and after removal of crystalloid. Both direct removal of crystalloid and ultrafiltration resulted in significant reduction in biochemical and metabolic load of blood (P < 0.001). However, the final composition of the prime was far from being physiological. Hemodiafiltration resulted in improvement of metabolic parameters to near physiological range (lactate: 33.8 ± 4.44 vs. 14 ± 2.53 mg/dL, pH: 7.05 ± 0.15 vs. 7.34 ± 0.06, bicarbonates: 4.83 ± 0.59 vs. 27.6 ± 2.94 meq/L; P < 0.001). Similarly, sodium (147.76 ± 12.73 vs. 144.6 ± 5.96 meq/L) and potassium (9.6 ± 2.83 vs. 4.23 ± 0.37 meq/L) also changed significantly (P < 0.001) to near physiologic range. Hemodiafiltraion of final prime is a simple, efficients and rapid method of correcting the biochemical parameters and reducing the metabolic load of stored PRBCs towards the physiological range before initiating the CPB.

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Section: Discussioncontrasting

confidence: 99%

Hemodiafiltration—A Technique for Physiological Correction of Priming Solution in Pediatric Cardiac Surgery: An In Vitro Study

et al. 2016

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“…Although these methods may help to protect the pulmonary vascular bed to some extent, the clinical application of these agents is limited due to unproven safety and cost-effectiveness. Ultrafiltration after cardiopulmonary bypass, either conventional or modified, is believed to be an effective measure to ameliorate inflammatory reactions by eliminating inflammatory mediators (14, 15). This newly developed technique, however, focuses on the treatment, rather than the prevention, of systemic inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Aprotinin Attenuates the Elevation of Pulmonary Vascular Resistance After Cardiopulmonary Bypass

Yun

Rho

2006

J Korean Med Sci

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Pulmonary vascular resistance (PVR) is generally believed to be elevated after cardiopulmonary bypass (CPB) due to whole body inflammation. Aprotinin has an anti-inflammatory action, and it was hypothesized that aprotinin would attenuate the PVR increase induced by CPB. Ten mongrel dogs were placed under moderately hypothermic CPB for 2 hr. The experimental animals were divided into a control group (n=5, group I) and an aprotinin group (n=5, group II). In group II, aprotinin was administered during pre-bypass (50,000 KIU/kg) and post-bypass (10,000 KIU/kg) periods. Additional aprotinin (50,000 KIU/kg) was mixed in CPB priming solution. PVRs at pre-bypass and post-bypass 0, 1, 2, 3 hr were calculated, and lung tissue was obtained after the experiment. Post-bypass PVRs were significantly higher than prebypass levels in all animals (n=10, p<0.001). PVR elevation in group II was less than in group I at 3 hr post-bypass (p=0.0047). Water content of the lung was lower in group II (74±9.4%) compared to that of group I (83±9.5%), but the difference did not reach significance (p=0.076). Pathological examination showed a near normal lung structure in group II, whereas various inflammatory reactions were observed in group I. We concluded that aprotinin may attenuate CPB-induced PVR elevation through its anti-inflammatory effect.

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“…Shimpo and colleagues reported the presence of ammonia (NH 3 ) and bradykinin (12). Additionally, neutrophils in the residual plasma of packed RBCs have been reported to activate and release interleukin-8 and secretory phospholipase A 2 following transfusion (13).…”

Section: The Need and Problems Of Rbc Transfusion During Neonatal Carmentioning

confidence: 99%

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

Sturmer¹,

Beaty²,

Clingan³

et al. 2018

Transl Pediatr

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Abstract:The development and refinement of cardiopulmonary bypass (CPB) has made the repair of complex congenital heart defects possible in neonates and infants. In the past, the primary goal for these procedures was patient survival. Now that substantial survival rates have been achieved for even the most complex of repairs in these patients, focus has been given to the reduction of morbidity. Although a necessity for these complex neonatal and infant heart defect repairs, CPB can also be an important source of perioperative complications. Recent innovations have been developed to mitigate these risks and is the topic of this review. Specifically, we will discuss improvements in minimizing blood transfusions, CPB circuit design, monitoring, perfusion techniques, temperature management, and myocardial protection, and then conclude with a brief discussion of how further systematic improvements can be made in these areas.

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Ultrafiltration of the Priming Blood Before Cardiopulmonary Bypass Attenuates Inflammatory Response and Improves Postoperative Clinical Course in Pediatric Patients

Cited by 36 publications

References 0 publications

Hemodiafiltration—A Technique for Physiological Correction of Priming Solution in Pediatric Cardiac Surgery: An In Vitro Study

Hemodiafiltration—A Technique for Physiological Correction of Priming Solution in Pediatric Cardiac Surgery: An In Vitro Study

Aprotinin Attenuates the Elevation of Pulmonary Vascular Resistance After Cardiopulmonary Bypass

Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery

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