The Journal of extra-corporeal technology
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J Extra Corpor Technol · Mar 2014
Case ReportsOne-way valve malfunction in an extracorporeal membrane oxygenation priming circuit.
Developing technologies have changed both the components and the management style when extracorporeal membrane oxygenation (ECMO) is used to support critically ill cardiac and respiratory patients. The Cardiohelp system is a small, portable extracorporeal system just recently available within the United States. Manufacturing standards and quality processes have made mechanical failure and malfunction of extracorporeal components less common; however, there is still potential for mechanical failure or component malfunction before or during extracorporeal support. This case review describes the malfunction of a Retroguard unidirectional flow valve integrated into the priming setup of a Cardiohelp system during the priming process.
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The use of intravenous fluids is routine in patients undergoing surgery or critical illness; however, controversy still exists regarding optimum fluid therapy. Recent literature has examined the effects of different types, doses, and timing of intravenous fluid therapy. Each of these factors may influence patient outcomes. ⋯ Crystalloid solutions with a chloride-rich composition (e.g., isotonic saline) have been associated with metabolic acidosis, hyperchloremia, increased incidence of acute kidney injury, and increased requirement for renal replacement therapy. An optimum dose of intravenous fluids remains controversial with no definitive evidence to support restrictive versus liberal approaches. Further high-quality trials are needed to elucidate the optimum fluid therapy for patients, but currently a balanced approach to type, dose, and timing of fluids is recommended.
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J Extra Corpor Technol · Dec 2013
Observational StudyHeparin dose and postoperative bleeding in patients undergoing cardiopulmonary bypass.
Heparin is the most widely used anticoagulant for cardiopulmonary bypass (CPB). Several authors suggest that lower doses of heparin during CPB would produce lower postoperative chest tube losses and fewer transfusion events. In the present study, a heparin dose-response (HDR) test was used to determine the heparin dose for each patient. ⋯ The heparin-resistant group was noninferior to the sensitive group and had clinically fewer transfused patients and transfusion events. The resistant group was noninferior to the sensitive group with respect to chest tube losses at all measured time points. Higher doses of heparin determined by a HDR test do not cause increased postoperative chest tube losses or increased transfusion events.