Objectives:To evaluate the effectiveness of hemofiltration during longstanding cardiopulmonary bypass (CPB) in patients with comorbidities.
Materials and Methods:Prospective randomized clinical trial included 38 male patients with ex-pecting duration of CPB >120 minutes due to comorbid pathology. Standard anesthesia protocol was carried out. Study includes two groups: first group (controlled, n=20) included standard CPB, 2 nd group (analyzed, n=18) included perfusion with high-volume hemofiltration using polyionic buffered solution 80 mL/min during all CPB time. Hemofiltration has been also supported by ultra-filtration for hydro-balance maintenance at the level of 8-10 mL/kg. Laboratory tests, respiratory and renal complications, drainage blood loss, hemostasis disorders, requiring hemostatics and blood transfusion, intensive care unit (ICU) and in-hospital were evaluated. Nonparametric methods-Mann-Whitney U test for independent samples and Wilcoxon signed-rank test for dependent samples were used.Results: IL-6 level in 2 nd group was significantly lower (p=0.0017) and did not exceed 7.4 pg/mL. C-RP, metalloproteinase and procalcitonin levels were lower too, but not statistically significant. Lactate level in analyzed group was in reference range, while in control group after perfusion it in-creased to 8.3±4.2 mmol/L. Renal dysfunction, requiring dialysis, was diagnosed in six (20,7%) patients from controlled group vs two patients (6.1%) from analyzed group. Respiratory insufficiency
Abstract
Research ArticleAddress for Correspondence: Vladimir Chagirev, A.V.
Objective: to study the clinical efficiency of introducing an algorithm for organ protective intensive care. Materials and methods. 3278 case histories of patients admitted to the clinic in 2000-2009 for surgical treatment (under extracorpore al circulation) for coronary heart disease (CHD) and acquired heart defects (AHD) were retrospectively analyzed. Throughout the analyzed period, the patients operated on for CHD and AHD were 2068 (63.1%) and 1210 (36.9%), respectively; the postoperative incidence of multiple organ dysfunction (MOD) among all the patients was 11.8% (378 patients); mortality in MOD was 3.75% (n=123) of the operated patients (included into the study) or 32.5% of all the patients with MOD. Conclusion. The incidence of MOD is in proportion to the number of surgical interventions and depends on their specific features (recurrence, baseline severity, comorbidity, or multifocal atherosclerosis). Preventive intensive therapy for MOD reduced mortality and altered its syndromic pattern towards a preponderance of pyoseptic complications.
To evaluate the parameters of the thrombin generation test (TGT) in coronary artery disease (CAD) patients on prolonged aspirin therapy during on-pump coronary artery bypass grafting (CABG) after donor platelet concentrate transfusion. A total of 148 patients with CAD on prolonged aspirin therapy (75–100 mg/day) who have undergone elective on-pump CABG were consecutively included in the study. Patients were divided randomly into two groups. Group 1 (n = 76) received donor platelet transfusions after cardiopulmonary bypass, whereas Group 2 (n = 72) did not. TGT parameters were measured using an analyzer at pre-, intra-, and early postoperative periods. Activation of the endogenous thrombin potential was observed in patients on prolonged aspirin therapy in the pre- and intraoperative periods, as confirmed by high peak thrombin and increased velocity index. The activation time of the prothrombinase complex and thrombin generation time were greater than the control group. The blood hemostatic potential in patients who did not receive transfusions in the early postoperative period decreased up to the level of the control group in the extended time parameters. Hemostatic potential in plasma in patients on aspirin was preserved. Given the laboratory test results and clinical data, platelet concentrate transfusion is unnecessary for prevention.
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