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Lehmann S, Dieterlen MT, Flister A, Klaeske K, Jawad K, Garbade J, Borger MA, Kostelka M. Differences of early immunological responses in on-pump versus off-pump cardiac surgery. Perfusion 2019; 34:399-407. [PMID: 31234755 DOI: 10.1177/0267659118823137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cardiopulmonary bypass surgery is accompanied by an inflammatory response and pulmonary dysfunction that renders patients vulnerable to postoperative complications. The majority of studies investigating the inflammatory response in cardiopulmonary bypass focus on cytokine measurements. This study investigated the early response of peripheral blood cell types and early changes in lung tissue in on-pump versus off-pump cardiopulmonary bypass surgery. METHODS Landrace pigs were assigned to the following groups (n = 6 per group): 1. off-pump cardiopulmonary bypass, 2. conventional cardiopulmonary bypass, 3. heparin-coated cardiopulmonary bypass, 4. surface-reduced cardiopulmonary bypass, and 5. surface-reduced cardiopulmonary bypass plus lung perfusion. Surgery was performed under mild hyperthermia (32°C), with 90-minute ischemia and 180-minute reperfusion. Histological and flow cytometric analyses were performed. RESULTS Lung water content increased during reperfusion in heparin-coated (84.63 ± 2.99%) compared to conventional cardiopulmonary bypass (76.33 ± 4.56%, p = 0.04). Alveolar septal thickness increased during ischemia at heparin-coated (p < 0.01) and surface-reduced cardiopulmonary bypass plus lung perfusion (p = 0.05). Tumor necrosis factor expression increased significantly (p < 0.01) in peribronchial, perivascular, and peripheral lung areas in all on-pump groups, but not in off-pump cardiopulmonary bypass. The usage of heparin-coated cardiopulmonary bypass led to increased percentages of CD3+CD4+ (p = 0.03) and CD3+CD8+ (p = 0.01) T cells compared to an uncoated device. Natural killer and mature B lymphocytes decreased at conventional and surface-reduced cardiopulmonary bypass plus lung perfusion. Activated granulocytes and macrophages increased at conventional cardiopulmonary bypass and heparin-coated cardiopulmonary bypass. CONCLUSION Off-pump cardiopulmonary bypass induces less immunological response and lung injury than on-pump surgery. The reduction of cardiopulmonary bypass surface reduces the inflammatory immune response induced by cardiopulmonary bypass. Lung perfusion of surface-reduced cardiopulmonary bypass diminished the extravasation caused by surface reduction of the cardiopulmonary bypass.
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Affiliation(s)
- Sven Lehmann
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Maja-Theresa Dieterlen
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Anja Flister
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Kristin Klaeske
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, Heart Center, HELIOS Clinic, University Hospital Leipzig, Leipzig, Germany
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Zochios V, Klein AA, Gao F. Protective Invasive Ventilation in Cardiac Surgery: A Systematic Review With a Focus on Acute Lung Injury in Adult Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2018; 32:1922-1936. [DOI: 10.1053/j.jvca.2017.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Indexed: 12/19/2022]
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Oliveira JM, Brinati A, Miranda LDL, Morais DB, Zanuncio JC, Gonçalves RV, Peluzio MDCG, Freitas MB. Exposure to the insecticide endosulfan induces liver morphology alterations and oxidative stress in fruit-eating bats (Artibeus lituratus). Int J Exp Pathol 2017; 98:17-25. [PMID: 28449369 DOI: 10.1111/iep.12223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/18/2017] [Indexed: 01/24/2023] Open
Abstract
Exposure to pesticides may increase the generation of reactive oxygen species (ROS), leading to oxidation of cell membrane lipids and proteins. Although fruit bats are potentially exposed to pesticides during their entire lifespan, the impacts of this exposure are still poorly investigated. We examined the effects of low, commercially recommended concentrations (0, 1.05 and 2.1 g/l) of an organochlorine insecticide endosulfan (EDS) formulation on oxidative responses in the liver and kidneys of Neotropical fruit bats (Artibeus lituratus), as well as possible liver morphological alterations following a 35-day oral exposure. Superoxide dismutase activity was significantly decreased upon exposure to 1.05 g/l of EDS in the liver and kidneys, catalase was decreased in the liver of 2.1 g/l EDS-exposed bats, while glutathione S-transferase was increased in the liver of 2.1 g/l EDS-exposed bats. Protein carbonyls increased following the exposure to the highest EDS dose tested. Endosulfan-induced morphological alterations in the liver included cell degeneration and cell death, with apparent cytoplasm lipid accumulation (steatosis) and pyknotic nuclei, karyolysis and deposit of collagen fibres. Our findings suggest that exposure to low concentrations of EDS induced a certain extent of oxidative damage in fruit bats, which may have led to liver morphological alterations.
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Affiliation(s)
- Jerusa Maria Oliveira
- Departamento de Biologia Geral, Universidade Federal de Viçosa, Vicosa, Minas Gerais, Brazil
| | - Alessandro Brinati
- Departamento de Ciências Biológicas, Universidade Estatual de Minas Gerais, Carangola, Minas Gerais, Brazil
| | | | - Danielle Barbosa Morais
- Departamento de Morfologia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - José Cola Zanuncio
- Departamento de Entomologia, Universidade Federal de Viçosa, Vicosa, Minas Gerais, Brazil
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Rodriguez-Blanco YF, Gologorsky A, Salerno TA, Lo K, Gologorsky E. Pulmonary Perfusion and Ventilation during Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes after Cardiac Surgery. Front Cardiovasc Med 2016; 3:47. [PMID: 27965964 PMCID: PMC5124755 DOI: 10.3389/fcvm.2016.00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/17/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Clinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass (CBP) are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent. DESIGN Retrospective case-control study. SETTINGS Major academic tertiary referral medical center. PARTICIPANTS Two hundred seventy-four consecutive patients who underwent open heart surgery with CBP 2009-2013. INTERVENTIONS The outcomes of 86 patients who received pulmonary perfusion and ventilation during CBP were retrospectively compared to the control group of 188 patients. MEASUREMENTS AND MAIN RESULTS Respiratory complications rates were similar in both groups (33.7 vs. 33.5%), as were the rates of postoperative pneumonia (4.7 vs. 4.3%), pleural effusions (13.9 vs. 12.2%), and re-intubations (9.3 vs. 9.1%). Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3 vs. 8.5%) and atrial fibrillation (33.7 vs. 28.2%) were equivalent in both groups. Incidence of sepsis (8.1 vs. 5.3%), postoperative stroke (2.3 vs. 2.1%), acute kidney injury (2.3 vs. 3.7%), and renal failure (5.8 vs. 3.7%) was likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8 vs. 5.3%, p = 0.031) and the need for mediastinal re-exploration (17.4 vs. 9.6%, p = 0.0633) were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. Intensive care unit (ICU) and hospital stays, and the ICU readmission rates (7.0 vs. 8.0%) were similar in both groups. CONCLUSION Simultaneous pulmonary perfusion and ventilation during CBP were not associated with improved clinical outcomes.
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Affiliation(s)
| | | | - Tomas Antonio Salerno
- Cardiovascular Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Kaming Lo
- Division of Biostatistics, Department of Public Health Sciences, University of Miami , Miami, FL , USA
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Gologorsky E, Gologorsky A, Salerno TA. Lung-Centered Open Heart Surgery: A Call for a Paradigm Change. Front Cardiovasc Med 2016; 3:12. [PMID: 27243021 PMCID: PMC4863883 DOI: 10.3389/fcvm.2016.00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/28/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Tomas Antonio Salerno
- Cardiovascular Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
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Lellouche F, Delorme M, Bussières J, Ouattara A. Perioperative ventilatory strategies in cardiac surgery. Best Pract Res Clin Anaesthesiol 2015; 29:381-95. [PMID: 26643102 PMCID: PMC10068651 DOI: 10.1016/j.bpa.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/22/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023]
Abstract
Recent data promote the utilization of prophylactic protective ventilation even in patients without acute respiratory distress syndrome (ARDS), and especially after cardiac surgery. The implementation of specific perioperative ventilatory strategies in patients undergoing cardiac surgery can improve both respiratory and extra-pulmonary outcomes. Protective ventilation is not limited to tidal volume reduction. The major components of ventilatory management include assist-controlled mechanical ventilation with low tidal volumes (6-8 mL kg(-1) of predicted body weight) associated with higher positive end-expiratory pressure (PEEP), limitation of fraction of inspired oxygen (FiO2), ventilation maintenance during cardiopulmonary bypass, and finally recruitment maneuvers. In order for such strategies to be fully effective, they should be integrated into a multimodal approach beginning from the induction and continuing over the postoperative period.
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Affiliation(s)
- François Lellouche
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculté de Médecine, Université Laval, Ville de Québec, Canada.
| | - Mathieu Delorme
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculté de Médecine, Université Laval, Ville de Québec, Canada; CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Univ. Bordeaux, Adaptation Cardiovasculaire à l'ischémie, U1034 et INSERM, Adaptation Cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France.
| | - Jean Bussières
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculté de Médecine, Université Laval, Ville de Québec, Canada.
| | - Alexandre Ouattara
- CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Univ. Bordeaux, Adaptation Cardiovasculaire à l'ischémie, U1034 et INSERM, Adaptation Cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France.
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Postfiltration und Lungenperfusion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gologorsky E, Macedo FI, Salerno TA. Beating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits? Expert Rev Cardiovasc Ther 2014; 9:927-37. [DOI: 10.1586/erc.11.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Macedo FIB, Panos AL, Andreopoulos FM, Salerno TA, Pham SM. Lung perfusion and ventilation during implantation of left ventricular assist device as a strategy to avoid postoperative pulmonary complications and right ventricular failure. Interact Cardiovasc Thorac Surg 2013; 17:764-6. [PMID: 23933964 DOI: 10.1093/icvts/ivt349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Right ventricular failure is a major contributor to increased morbidity and mortality in patients undergoing left ventricular assist device implantation. Cardiopulmonary bypass is associated with increased pulmonary ischaemia and pulmonary vascular resistance. Continuous pulmonary perfusion and ventilation represents an emerging strategy for pulmonary protection during cardiac surgery. We hypothesize that this technique may have a pivotal role in reducing postoperative right ventricular dysfunction in high-risk patients undergoing LVAD placement.
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Affiliation(s)
- Francisco Igor B Macedo
- Division of Cardiothoracic Surgery, Heart/Lung Transplantation and Artificial Heart Programs, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
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Salerno TA, Macedo FIB, Gologorsky E. Pulmonary Ventilation Should Be Matched With Pulmonary Perfusion During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2012; 26:e60. [DOI: 10.1053/j.jvca.2012.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Indexed: 11/11/2022]
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Schreiber JU, Lancé MD, de Korte M, Artmann T, Aleksic I, Kranke P. The Effect of Different Lung-Protective Strategies in Patients During Cardiopulmonary Bypass: A Meta-Analysis and Semiquantitative Review of Randomized Trials. J Cardiothorac Vasc Anesth 2012; 26:448-54. [DOI: 10.1053/j.jvca.2012.01.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Indexed: 12/31/2022]
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Stratégie ventilatoire peropératoire en chirurgie cardiaque: vers une approche multimodale. ACTA ACUST UNITED AC 2012; 31 Suppl 1:S2-4. [DOI: 10.1016/s0750-7658(12)70044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gabriel EA, Montevilla FMA, Chida VV, Dias FN, Montoya CV, Otsubo H, Pires ZF, Nogaroto SL. Experimental research with synthetic copolymer-coated cardiopulmonary bypass circuits: inflammatory and thrombogenicity analysis. Artif Organs 2011; 36:110-4. [PMID: 21848861 DOI: 10.1111/j.1525-1594.2011.01291.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aimed to assess complement system activation and index of thrombogenicity and platelet aggregation between synthetic copolymer-coated cardiopulmonary bypass (CPB) circuit and conventional CPB circuit. Twenty-six pigs were equally divided into two groups--the conventional group and the coated group. They were placed on CPB for 90 min, and blood samples were collected at three different time points (T0, right before CPB establishment; T1, 45 min after starting CPB; and T2, 90 min after starting CPB) to measure total count of inflammatory cells (leukocytes, neutrophils, lymphocytes, and platelets) and serum levels of fraction C3 of complement system. Upon completion of the 90-min CPB, fragments of different compartments of the CPB circuit were taken for assessing index of thrombogenicity and platelet aggregation. There were no differences between both groups regarding total count of leukocytes, neutrophils, and lymphocytes; however, there was a lower count of platelets at T2 in the coated group (P = 0.020). The serum level of fraction C3 was lower in the coated group at T1 (P = 0.020) and T2 (P = 0.017). Higher index of thrombogenicity and platelet aggregation were detected in the conventional group (77% of the animals within the conventional group) than in the coated group (46% of the animals within the coated group). In conclusion, in heart surgery requiring CPB, the use of synthetic copolymer-coated CPB circuit may be useful to reduce complement system activation, as well as attenuating index of thrombogenicity and platelet aggregation.
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Affiliation(s)
- Edmo Atique Gabriel
- Albert Einstein Jewish Hospital, Experimental Surgery Center, São Paulo, Brazil.
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Zhang R, Wang Z, Wang H, Song H, Zhang N, Fang M. Effective pulmonary artery perfusion mode during cardiopulmonary bypass. Heart Surg Forum 2011; 14:E18-21. [PMID: 21345772 DOI: 10.1532/hsf98.20101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Reducing lung injury during cardiopulmonary bypass (CPB) is important for patients' recovery. The present study was designed to research convenient and effective pulmonary artery perfusion mode during CPB in an animal model. METHODS Twelve healthy mongrel dogs were randomly divided into 2 groups: a control group and a perfusion group designed to simulate clinical CPB-induced lung injury. During CPB, pulmonary artery perfusion with modified low-potassium dextran (LPD) solution was performed immediately after the initiation of ischemia and before reperfusion for 3 to 4 minutes each time, with pressure maintained at 15 to 20 mmHg; animals in the control group were not perfused. After pulmonary reperfusion, the changes in pulmonary function and tissue biochemical data were determined. RESULTS Compared with the control group, lung compliance, oxygenation, and vascular resistance after reperfusion were significantly improved in the perfusion group. The malonaldehyde concentration, neutrophil sequestration ratio, and tissue water content also decreased significantly in the perfusion group. CONCLUSION The pulmonary artery perfusion mode used in this experiment could relieve CPB-induced lung injury effectively. Improving cellular tolerance to hypoxia and decreasing inflammatory reaction may be the important mechanisms. Moreover, this mode is convenient and does not interfere with the intended operations, which is promising for clinical use.
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Affiliation(s)
- Renteng Zhang
- Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
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Macedo FIB, Gologorsky E, Salerno TA. Beating-heart valve surgery: is the introduction of lung perfusion/ventilation the next step? Future Cardiol 2011; 7:61-7. [DOI: 10.2217/fca.10.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Myocardial and pulmonary ischemia during cardiopulmonary bypass has been associated with postoperative cardiac and pulmonary dysfunction, as well as poor outcomes. Beating-heart valve surgery utilizing continuous coronary perfusion with warm oxygenated blood via the antegrade/retrograde routes, is a novel strategy for myocardial protection. Conceptually, it is proposed that maintenance of pulmonary perfusion and ventilation during the cardiopulmonary bypass period also might be advantageous. The most current evidence regarding these evolving techniques and further areas of research are discussed in this article.
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Affiliation(s)
- Francisco Igor B Macedo
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA
| | - Edward Gologorsky
- Department of Anesthesiology, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA
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Macedo FIB, Carvalho EM, Gologorsky E, Barron M, Hassan M, Salerno TA. Gas Exchange during Lung Perfusion/Ventilation during Cardiopulmonary Bypass: Preliminary Results of a Pilot Study. Open J Cardiovasc Surg 2010. [DOI: 10.4137/ojcs.s4109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lung perfusion/ventilation was introduced as a means to minimize cardiopulmonary (CPB)-related pulmonary ischemic injury. Current results in the literature are divergent, and the role of gas exchange during lung perfusion/ventilation during CPB, remains undefined. This report details a) the technique of continuous lung perfusion/ventilation during CPB, b) provides initial observations, and c) discusses gas exchange during CPB.
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Affiliation(s)
| | | | - Edward Gologorsky
- Department of Anesthesiology, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Michael Barron
- Department of Anesthesiology, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
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