Open-heart Patients Research Articles

Technique for Improved Patient Care: Initial Experience with the GEM-6

(J. Extra-Corpor. Technol. 20[1]: p. 46–51 Spring 1988) In our institution, a “stat” lab is not available in close proximity to the OR. The problem of receiving lab results quickly (within 5-8 minutes) while on cardiopulmonary bypass was a persistent problem. Therefore, the decision was made to evaluate the GEM-6, a relatively new on-line blood gas, electrolyte, and hematocrit monitor for the heart-lung machine. for the first 30 days of use, simultaneous results were obtained from the GEM-6 and the hospital lab. Our lag time receiving results was greatly reduced and the lab values compared favorably with the hospital lab. The least reliable value with the original cartridge and software was the hematocrit levels. Hematocrits measured by the GEM-6 consistently were 2-5% higher than the hospital lab results. This problem appears to be proportionately related to the patient’s serum sodium level. Due to decreased work load on OR personnel, reliability, quickly obtainable results, and multiple parameters available with the GEM-6, we instituted use of the GEM-6 in January 1987. Through the use of Quality Assurance monitors and comparative Recovery Room first blood gases as QA monitors on open heart patients, documentation of improved patient care through the use of this on-line instrument is provided. Lab values readily available to the perfusionist can indeed result in the “fine tuning” of the pump run with improved patient care.

The microbiologic risk of invasive haemodynamic monitoring in open-heart patients requiring prolonged ICU treatment.

The microbiologic risk of invasive haemodynamic monitoring and support was prospectively studied in 48 patients undergoing open-heart surgery under antibiotic prophylaxis and requiring intensive care for longer than 4 days. A total of 420 catheter tips were cultured of which 12 (2.9%) were positive. The incidence of positive catheter tip cultures was as follows: intravenous 1.8%, central venous 1.2%, arterial 1.8%, pulmonary arterial 5.9%, direct right atrial 2.4%, direct left atrial 0% and intra-aortic balloon pump catheters 7.7%. The rate of positive tip cultures was not significantly different for percutaneously and surgically inserted catheters (3.1% and 1.7% respectively). One (0.2%) catheter was associated with bacteraemia. Although the overall positive catheter tip culture rate was low, 21% of the patients had one or more positive catheter tip cultures. Complicated surgical procedures, a cardiopulmonary bypass time longer than 3.5 h, mechanical ventilation for more than 7 days, intensive care stay longer than 10 days, positive blood cultures and the use of more than 20 catheters were all individually associated with a significantly higher incidence of patients with positive tip cultures. Nevertheless, no patient developed endocarditis nor major morbidity related to the positive catheter tip cultures. Invasive haemodynamic monitoring does not seem to be an important microbiologic risk in open-heart patients requiring intensive care for longer than 4 days.

Computerized Data Acquisition and Data Management for the Open Heart Patient

(J. Extra-Corpor. Technol. 19[3] p. 287-289 Fall 1987) We have developed a complete system for acquiring data directly from electronic monitoring devices in the OR and ICU. In addition, this system maintains a database used for documentation of clinical management, report generation, and archival analysis of general patient information and clinical treatment. This system is microcomputer based and file driven. Monitoring of patients occurs in the operating room, ICU, office, and at home via modem. Since the system is file driven, it can be configured for any operation. It can be reconfigured at any time, including during an operation as clinical situations dictate. Data is entered simultaneously from direct interface with monitoring devices and also manually. And as data is entered, new calculations are performed (i.e., SVR, LVSWI) to provide current clinical data so decisions in clinical management can be made.

Rises in antibody to enteric gram negative bacilli after open heart surgery: a possible mechanism for postoperative pyrexia.

Paired sera, taken before operation and 10-14 days after operation from 64 patients having open heart surgery and 10 having closed heart surgery, were examined for agglutinins to seven common serotypes of Escherichia coli. The results showed that, while 20% of both groups of patients had detectable agglutinins before operation, new antibodies appeared after operation in 69% of patients having open heart surgery compared with only 10% of those having closed heart surgery, a significant difference. Thirty six pairs of sera were also examined for the preoperative presence and postoperative development of antiendotoxin. Of 22 open heart patients shown not to possess antiendotoxin before operation, 18 showed the antibody after operation, whereas none of the eight seronegative patients acquired the antibody after closed heart surgery-again a highly significant difference. These results are consistent with the hypothesis that endotoxin and other products of enteric Gram negative bacilli circulate shortly after cardiopulmonary bypass, possibly arising directly from the gut and perhaps explaining the pyrexia seen commonly at this time.

Rôle des transfusions au cours des infections à cytomégalovirus post-chirurgicales: chez des sujets non immunodéprimés

Cytomegalovirus (CMV) infection is most frequently observed after open heart surgery with extracorporeal circulation (ECC) and common after thoracic surgery without ECC and after splenectomies though very rare after other types of surgery. Studies on open heart patients with ECC carried out in the period 1968-1979 show an average seroconversion rate of 28% while the febrile mononucleosis syndrome rate would amount to 4.2%. Seroconversion is defined as a confirmed increase in the titer of complement fixing (CF) antibody by a factor of 4 or more. The risk of CMV infection is proportional to the quantity of blood transfused. Fresh blood was initially suspected of being the cause, but later investigator have found no difference between fresh and preserved blood. Seroconversion and/or infection risks can be sharply cut by using deleukocyted blood or frozen deglycerolized erythrocytes free of viable leukocytes. Seroconversion risk increases significantly when CMV (CF) antibodies are present in transfused blood. However, the presence of these antibodies in the recipient's blood appears to afford protection against seroconversion and/or infection, except in the case of immunodepressed patients. In conclusion, CMV febrile mononucleosis syndrome might be due to latent CMV in the transfused blood. This transfusion of allogenic blood might induce an immunological reaction that reactivates the latent CMV transmitted to recipient.

Early Clinical Experiences with Terumo’s New Hollow Fiber Membrane Oxygenator: Capiox II

Terumo’s Capiox II is a hollow fiber membrane oxygenator with an integrated heat exchanger. This device is available in 1.6 m2, 3.3 m2, 4.3 m2, and 5.4 m2 sizes. Our clinical experiences have been with the 3.3 m2, 4.3 m2, and 5.4 m2 sizes, in over 150 open-heart patients. The 3.3 m2 was sized to patients up to 60 kg. The 5.4 m2 was used in all patients >60 kg. Both normothermic and hypothermic (24°-30° bladder) perfusions were performed. The heat exchanger was efficient and demonstrated structural integrity. On bypass, patient vital signs, gas and blood flows, arterial and venous blood gases and blood chemistries were monitored. Arterial saturations were 100%. Venous saturations were at least 65%. No acid-base problems were encountered. Initially, 100% oxygen was used. Later a gas blender using O2 and compressed air was utilized. Our experience concludes that the Capiox II is a safe, efficient onepump membrane oxygenator with integral heat exchanger. It is easy to set up and recirculate, delivering satisfactory oxygen transfer rates with a blended gas to blood flow ratio (≤1:1).

Prediction of cerebral outcome after extracorporeal circulation.

50 open-heart patients were investigated using simultaneous clinical, electroencephalographical (EEG) and neuropsychological evaluation in order to assess the possibilities of predicting the postoperative outcome with preoperative measures. The presence of one or more of the following indices was prognostically unfavourable: a history of cerebrovascular diseases or syncope; delta or sharp wave EEG abnormalities or low quantitative EEG mean frequency; a poor performance score in one of the psychometric tests (colour naming). Using these measures, 28 cases with presumably high risks were indicated, and 24 (86%) sustained cerebral complications attributable to the operation. The observations contrast clearly with previous studies whose predictions, using only one single criterion, have proved invalid. A significant level of prediction seems to be obtainable, but only by the simultaneous consideration of several different cerebral functions. The prognostic approach may offer one way of achieving the necessarily needed improved cerebral safety in cardiac surgery.

Early postsurgical bacterial contamination of the airways: a study on 28 open-heart patients.

One pre- and two postoperative cultures of tracheo-bronchial secretions were obtained from 28 cardiac patients, subjected to open-heart surgery. Four patients received preoperative antibiotics, and all but one received postoperative prophylactic antibiotics. Preoperatively, only one patient had potential pathogens; after surgery (mean intubation time 4.2 h), four patients (14.3%) had organisms; and after 19 h of intubation, 28% of the patients had potential pathogens in their tracheo-bronchial secretions. Only three of the seven organisms recovered from the last sample were clearly sensitive to the antibiotics given prophylactically; and two of these organisms were Group A beta-haemolytic streptococci. The early presence of organisms in the airways after intubation, the high incidence of colonization, and the ineffectiveness of prophylactic antibiotics in preventing this contamination are pointed out. The factors that may possibly influence colonization of airways among these patients are commented on.

Patterns of sympathetic neuron activity associated with Mayer waves.

Patterns of sympathetic neuron activity associated with Mayer waves.

Sympathetic unit activity associated with Mayer waves in the spinal dog.

Sympathetic unit activity associated with Mayer waves in the spinal dog.

Serum transaminase levels following cross-clamping of the aorta in open heart surgery without coronary artery perfusion.

A study was carried out on 25 patients who underwent open heart surgery, with cross-clamping of the aorta but without perfusion of the coronary arteries to ascertain whether this produced any adverse effect on the myocardium. Serum enzyme levels (glutamic oxalacetic transaminase and glutamic pyruvic transaminase) were estimated on the first, third, seventh, and twenty-first postoperative days, these results being compared with two groups of controls; the first, 19 patients who had lung resection, and the second, 20 patients who underwent closed mitral valvotomy. The mean levels remained normal in the two control groups, but were markedly elevated on the first and third days after operation in the open heart patients, in whom they had returned to normal by the twenty-first day. No correlation was found between the transaminase levels and the duration of either the perfusion or the coronary occlusion. Four deaths occurred in the 25 patients, in only one of which could death be attributed to the technique. The survivors have shown no evidence of impaired myocardial function, and the technique appears effective and safe when limited to a maximum of 60 minutes of continuous aortic occlusion.

Comparison of postoperative glycoprotein responses in open-heart and nonopen-heart patients.

ARTICLESComparison of postoperative glycoprotein responses in open-heart and nonopen-heart patientsH. W. Wallace, K. Arai, and W. S. BlakemoreH. W. Wallace, K. Arai, and W. S. BlakemorePublished Online:01 Apr 1970https://doi.org/10.1152/jappl.1970.28.4.433MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation More from this issue > Volume 28Issue 4April 1970Pages 433-438 Copyright & PermissionsCopyright © 1970 the American Physiological Societyhttps://doi.org/10.1152/jappl.1970.28.4.433PubMed4191161History Published online 1 April 1970 Published in print 1 April 1970 Metrics

Reduced protamine dosage for heparin neutralization in open-heart operations.

Two comparable groups of open-heart patients were given 0.79 and 1.37 mg of protamine for neutralization of exogenous heparin. The influence of protamine dosage on postoperative bleeding was then evaluated. The lower protamine dosage was associated with a more rapid neutralization of heparin, reduced postoperative blood loss, and a reduced incidence of exploratory thoracotomy for excessive bleeding.

The Nursing Care of the Open Heart Patient

The recovery of the open heart patient depends on good nursing care and is often very rapid. In a very successful case the patient will be sitting up the evening of surgery, dangling the first postoperative day, out of bed in a chair the second, and walking the third. He may be discharged as soon as a week following surgery. The patient's rate of recovery is an individual matter. He will determine his own activity by his condition. We usually let the patient be the guide in determining his limitations and progress. It is both thrilling and rewarding to see this type of progress in a patient. To quote Dr. James Jude, chief of cardiovascular surgery at Jackson Memorial Hospital, "The future of cardiac nursing is bright. It calls for those who desire to give their hearts to the healing of hearts of others."

Hypoxia of the lung parenchyma during cardiopulmonary bypass.

PULMONARY parenchymal hemorrhage in cases undergoing open heart surgery using cardiopulmonary bypass may well be caused by hypoxia in the lungs. Three important factors seem to be involved in the hypoxic production of pulmonary parenchymal hemorrhage: pulmonary artery flow, bronchial arterial oxygen saturation, and bronchial arterial flow. A considerable amount of clinical and experimental work has been done to determine the cause of pulmonary parenchymal changes occurring during cardiopulmonary bypass. Gibbon,¹in his early work with cardiopulmonary bypass, unexpectedly found that postoperative pulmonary dysfunction was contributing more than other complications to the morbidity after open heart operations. He published a paper reporting his findings in 1959. One year before Gibbon's paper was actually published, Dodrill²reported that pulmonary problems accounted for at least 15% to 25% of deaths following heart surgery. Kirklin³et al found pulmonary complications in early open heart patients and con sidered inadequate perfusion

CARDIORESPIRATORY RESPONSE TO ANAESTHESIA AND SURGERY IN OPEN‐HEART PATIENTS

Acta Anaesthesiologica ScandinavicaVolume 8, Issue s15 p. 102-102 CARDIORESPIRATORY RESPONSE TO ANAESTHESIA AND SURGERY IN OPEN-HEART PATIENTS O. P. Norlander, O. P. Norlander StockholmSearch for more papers by this authorN. Thung, N. Thung StockholmSearch for more papers by this authorW. Markham, W. Markham StockholmSearch for more papers by this author O. P. Norlander, O. P. Norlander StockholmSearch for more papers by this authorN. Thung, N. Thung StockholmSearch for more papers by this authorW. Markham, W. Markham StockholmSearch for more papers by this author First published: December 1964 https://doi.org/10.1111/j.1399-6576.1964.tb00279.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume8, Issues15December 1964Pages 102-102 RelatedInformation

Study of acid-base balance in open-heart surgical patients.

So-called normal respiratory and metabolic acid-base responses to anaesthesia, surgery, and by-pass in open-heart patients has been described. Careful monitoring of these parameters allows for early correction of deviations. The immediate postoperative management of infants and patients with aortic valvular disease may be improved by these means.

A special care unit for the postoperative open cardiotomy patient ∗

Skillful postoperative management, especially during the critical first twenty-four to thirty-six hours, is essential to the success of open cardiotomy for the surgical correction of cardiac defects. The organization and use of a Special Care Unit for the postoperative open heart patient are described. The problems of immediate postoperative care, such as optimal respiratory function, cardiovasular stability, maintenance of normal body temperature, electrolyte balance and the treatment of any complications arising as the result of operation or perfusion, are discussed. The use of precise monitoring instruments in specific ways to guide the physician in the diagnosis and treatment of the postoperative cardiac patient is presented.

Pre- and post-operative care of patients undergoing open cardiac surgery.

As considerable and widespread interest in open cardiac surgery has developed, many papers have appeared describing the various techniques and results with use of extracorporeal circulatory systems. However, the important aspects of pre and postoperative care of the open heart patients have received much less attention. This omission is indeed significant for given a group of cardiac patients with a good total body perfusion and a good surgical repair of their cardiac lesions, the difference between a very low operative risk and a higher mortality is often made by the attention given to details of management in the immediate pre and postoperative intervals. Therefore, it may be of value to others to examine suggestions based on experiences gained at the University of Minnesota Hospitals during the past five years in which period more than 700 open cardiac operations were performed.