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Andersen LW. Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management. Anesth Analg 2017; 125:743-752. [PMID: 28277327 DOI: 10.1213/ane.0000000000001928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Elevated lactate is a common occurrence after cardiac surgery. This review summarizes the literature on the complex etiology of lactate elevation during and after cardiac surgery, including considerations of oxygen delivery, oxygen utilization, increased metabolism, lactate clearance, medications and fluids, and postoperative complications. Second, the association between lactate and a variety of outcomes are described, and the prognostic role of lactate is critically assessed. Despite the fact that elevated lactate is strongly associated with many important outcomes, including postoperative complications, length of stay, and mortality, little is known about the optimal management of postoperative patients with lactate elevations. This review ends with an assessment of the limited literature on this subject.
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Affiliation(s)
- Lars W Andersen
- From the *Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; †Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ‡Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; and §Department of Medicine, Regional Hospital Holstebro, Aarhus University, Holstebro, Denmark
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WALKER WF, MORGAN HG, BRECKENRIDGE IM, WATT A, OGILVIE RR, DOUGLAS DM. The Biochemical Response to Open Heart Surgery Using Extra-Corporeal Circulation. Scott Med J 2016; 8:141-8. [PMID: 13998522 DOI: 10.1177/003693306300800403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chioléro RL, Revelly JP, Leverve X, Gersbach P, Cayeux MC, Berger MM, Tappy L. Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med 2000; 28:3784-91. [PMID: 11153615 DOI: 10.1097/00003246-200012000-00002] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hyperlactatemia is a prominent feature of cardiogenic shock. It can be attributed to increased tissue production of lactate related to dysoxia and to impaired utilization of lactate caused by liver and tissue underperfusion. The aim of this prospective observational study was to determine the relative importance of these mechanisms during cardiogenic shock. PATIENTS Two groups of subjects were compared: seven cardiac surgery patients with postoperative cardiogenic shock and seven healthy volunteers. METHODS Lactate metabolism was assessed by using two independent methods: a) a pharmacokinetic approach based on lactate plasma level decay after the infusion of 2.5 mmol x kg(-1) of sodium lactate; and b) an isotope dilution technique for which the transformation of [13C]lactate into [13C]glucose and 13CO2 was measured. Glucose turnover was determined using 6,62H2-glucose. RESULTS All patients suffered from profound shock requiring high doses of inotropes and vasopressors. Mean arterial lactate amounted to 7.8 +/- 3.4 mmol x L(-1) and mean pH to 7.25 +/- 0.07. Lactate clearance was not different in the patients and controls (7.8 +/- 3.4 vs. 10.3 +/- 2.1 mL x kg(-1) x min(-1)). By contrast, lactate production was markedly enhanced in the patients (33.6 +/- 16.4 vs. 9.6 +/- 2.2 micromol x kg(-1) x min(-1); p < .01). Exogenous [13C]lactate oxidation was not different (107 +/- 37 vs. 103 +/- 4 mmol), and transformation of [13C]lactate into [13C]glucose was not different (20.0 +/- 13.7 vs. 15.2% +/- 6.0% of exogenous lactate). Endogenous glucose production was markedly increased in the patients (1.95 +/- 0.26 vs. 5.3 +/- 3.0 mg x kg(-1) x min(-1); p < .05 [10.8 +/- 1.4 vs. 29.4 +/- 16.7 micromol x kg(-1) x min(-1)]), whereas net carbohydrate oxidation was not different (1.7 +/- 0.5 vs. 1.3 +/- 0.3 mg x kg(-1) x min(-1) [9.4 +/- 2.8 vs. 7.2 +/- 1.7 micromol x kg(-1) x min(-1)]). CONCLUSIONS Hyperlactatemia in early postoperative cardiogenic shock was mainly related to increased tissue lactate production, whereas alterations of lactate utilization played only a minor role. Patients had hyperglycemia and increased nonoxidative glucose disposal, suggesting that glucose-induced stimulation of tissue glucose uptake and glycolysis may contribute significantly to hyperlactatemia.
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Affiliation(s)
- R L Chioléro
- Department of Anesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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ANDERSEN MN, HAMBRAEUS G. Physiologic and biochemical responses to prolonged extracorporeal circulation: experimental studies during four-hour perfusion. Ann Surg 1998; 153:592-8. [PMID: 13683151 PMCID: PMC1613902 DOI: 10.1097/00000658-196104000-00029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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BALLINGER WF, VOLLENWEIDER H, PIERUCCI L, TEMPLETON JY. Anaerobic metabolism and metabolic acidosis during cardiopulmonary bypass. Ann Surg 1998; 153:499-506. [PMID: 13686409 PMCID: PMC1613899 DOI: 10.1097/00000658-196104000-00003] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hayakawa A, Kuwata K, Era S, Sogami M, Shimonaka H, Yamamoto M, Dohi S, Hirose H. Alteration of redox state of human serum albumin in patients under anesthesia and invasive surgery. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL SCIENCES AND APPLICATIONS 1997; 698:27-33. [PMID: 9367190 DOI: 10.1016/s0378-4347(97)00274-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Human serum albumin is a mixture of mercapt- (HMA, reduced form) and nonmercaptalbumin (HNA, oxidized form). We studied the mercapt<-->nonmercapt conversion of human serum albumin, which reflects the redox state of the extracellular fluids, in cardiac and other common surgical_ patients using high-performance liquid chromatography. Mean values of [(HMA)/(HMA+HNA)]+/-standard deviation, fHMA+/-sigma], for patients who received common surgery (group 1) and cardiac surgery (group 2) at the start of anesthesia were 0.636+/-0.050 (n = 83) and 0.615+/-0.062 (n = 14), respectively. fHMA values were markedly lower than those for healthy male adults of 0.750+/-0.028 (n = 28). fHMA values increased at 24 h after the start of anesthesia and decreased on the 4th postoperative day in most of the patients. These postoperative changes were prominent in cardiac surgical patients. Although fHMA values after the 7th postoperative day recovered to those at the start of anesthesia in almost all of common surgical patients, those in cardiac surgical patients never recovered even on the 21st postoperative day.
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Affiliation(s)
- A Hayakawa
- Department of Anesthesiology, Gifu University School of Medicine, Japan
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NAHAS GG, MALM JR, MANGER WM, VEROSKY M, SULLIVAN SF. CONTROL OF ACIDOSIS AND THE USE OF TITRATED ACD BLOOD IN OPEN-HEART SURGERY. Ann Surg 1996; 160:1049-56. [PMID: 14246141 PMCID: PMC1408864 DOI: 10.1097/00000658-196412000-00018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Siegel LB, Dalton HJ, Hertzog JH, Hopkins RA, Hannan RL, Hauser GJ. Initial postoperative serum lactate levels predict survival in children after open heart surgery. Intensive Care Med 1996; 22:1418-23. [PMID: 8986498 DOI: 10.1007/bf01709563] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the relationship between postoperative serum lactate levels and outcome in children undergoing open heart surgery. DESIGN Prospective, noninterventional study. SETTING Pediatric intensive care unit (PICU) of a university hospital. PATIENTS 41 nonconsecutive children who had had cardiopulmonary bypass for repair of congenital heart disease. INTERVENTIONS None. MEASUREMENTS AND RESULTS Serum lactate levels were measured on admission to the PICU immediately after open heart surgery. Lactate levels were correlated with bypass and cross clamp times, estimated intraoperative blood loss, lowest temperature on bypass, admission Pediatric Risk of Mortality score, anion gap, and measures of postoperative morbidity. Mean lactate levels on admission to the PICU were 6.86 +/- 0.79 mmol/l for nonsurvivors (n = 7) and 2.38 +/- 0.13 mmol/l for survivors (n = 34) (p < 0.0001), and 4.87 +/- 0.7 mmol/l and 2.35 +/- 0.19 mmol/l, for patients with (n = 11) and without (n = 30) multiple organ system failure, respectively (p < 0.0001). Admission lactate levels correlated with all measurements of postoperative morbidity. A serum lactate level of greater than 4.2 mmol/l had a positive predictive value of 100% and a negative predictive value of 97% for postoperative death. CONCLUSIONS Initial postoperative serum lactate levels after pediatric open heart surgery may be predictive of outcome. Lactate levels are also higher in patients who go on to develop multiple organ system failure. Elevated postoperative lactate levels may reflect intraoperative tissue hypoperfusion, and measures aimed at increasing oxygen delivery, with normalization of lactate, may improve patient outcome.
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Affiliation(s)
- L B Siegel
- Division of Pediatric Critical Care, Mount Sinai Medical Center, New York, NY 10029, USA
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BURKE JF, PONTOPPIDAN H, WELCH CE. HIGH OUTPUT RESPIRATORY FAILURE: AN IMPORTANT CAUSE OF DEATH ASCRIBED TO PERITONITIS OR ILEUS. Ann Surg 1996; 158:581-95. [PMID: 14067506 PMCID: PMC1408445 DOI: 10.1097/00000658-196310000-00008] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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LITWIN MS, BERGENTZ SE, CARSTEN A, GELIN LE, RUDENSTAM CM, SOEDERHOLM B. HIDDEN ACIDOSIS FOLLOWING INTRAVASCULAR RED BLOOD CELL AGGREGATION IN DOGS: EFFECTS OF HIGH AND LOW VISCOSITY DEXTRAN. Ann Surg 1996; 161:532-8. [PMID: 14274856 PMCID: PMC1408976 DOI: 10.1097/00000658-196504000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Runge TM, Grover FL, Cohen DJ, Bohls FO, Ottmers SE, Saadatmanesh V. Comparison of a steady flow pump to a preload responsive pulsatile pump in left atrial-to-aorta bypass in canines. Artif Organs 1991; 15:35-41. [PMID: 1998489 DOI: 10.1111/j.1525-1594.1991.tb00757.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A unique preload responsive pulsatile pump was compared to a centrifugal pump in total cardiac support in 25-kg canines (n = 6, each group) in the left atrial-to-aorta mode during 5 h of ventricular fibrillation. With steady flow, there was immediate drop in output from 2.1 +/- 1.0 L/min to 1.4 +/- 0.3 L/min, followed by further reduction to 0.9 +/- 0.2 L/min during 5 h of ventricular fibrillation. With a pulsatile pump, there was no significant reduction from control of 2.4 +/- 0.6 L/min and no decline during 5 h of ventricular fibrillation. With steady flow, systemic vascular resistance (SVR) rose significantly from 1,762 dyne-s-cm-5 immediately on pump to 3,013 dyne-s-cm-5 at 5 h. With physiologic pulsatile flow, significant elevation of SVR did not occur. When stressed, due to diminished left atrial return, the centrifugal pump displayed line chatter and streaks of microbubbles, whereas the pulsatile pump did not. Crystalloid volume replacement with the centrifugal pump was 6.5 +/- 1.9 L, and with the preload responsive pulsatile pump, 5.6 +/- 1.3 L. It is concluded that in the left atrial-to-aorta mode during 5 h of ventricular fibrillation and with comparable volume replacement, total cardiac support of canines is associated with lower SVR with physiologic pulsatile flow and is not accompanied by line chatter and cavitation with this preload responsive pump.
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Affiliation(s)
- T M Runge
- Department of Surgery, University of Texas Health Science Center, San Antonio 78284
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Runge TM, Grover FL, Cohen DJ, Bohls FO, Ottmers SE. Preload-responsive, pulsatile-flow, externally valved pump: cardiopulmonary bypass. J INVEST SURG 1989; 2:269-79. [PMID: 2487256 DOI: 10.3109/08941938909057433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Currently two pumps are used for cardiopulmonary bypass, the roller pump and the centrifugal or vortex pump. Both are steady-flow pumps. The procedure of cardiopulmonary bypass possesses a finite morbidity and mortality. The degree to which steady flow is responsible for this morbidity and mortality remains to be clarified, but investigators have established the fact that a physiologic degree of pulsatile flow must be achieved before its beneficial results, such as normal systemic resistance and absence of lactate production, can be demonstrated. Availability of a satisfactory pulsatile pump for cardiopulmonary bypass has been a problem in the past but the pump presented here may satisfy this need. It produces physiologic pulsatility with rate dependent ejection time equal to or less than that of humans (413 microseconds minus 1.7 times heart rate), and it is preload-responsive, varying its pumping rate and output with filling pressure. The pump is externally valved to minimize hemolysis, which has been demonstrated in two laboratory studies to be significantly less than with the roller pump. It produces pulsatile flow through membrane oxygenators. The pump is thought to have potential for several clinical applications in addition to (1) pulsatile-flow cardiopulmonary bypass, including (2) left, right, or combined transthoracic QRS synchronized ventricular assist, (3) femoral vein to femoral artery QRS synchronized left ventricular assist, (4) adult or infant ECMO, (5) pulsatile flow hemodialysis. In the latter, spallation and embolization of hemodialysis tubing particles should not be a problem as has proved to be the case with the present hemodialysis pump.
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Affiliation(s)
- T M Runge
- Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842
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Schiavello R, Cavaliere F, Sollazzi L, Loffreda C, Marana E. Changes of serum pyruvate and lactate in open-heart surgery. Resuscitation 1984; 11:35-45. [PMID: 6142513 DOI: 10.1016/0300-9572(84)90032-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In 20 patients under extracorporeal bypass, a study was undertaken of the changes in plasma of lactate and pyruvate, the lactate/pyruvate ratio and the lactate excess. A decrease has been found in the pyruvate and an increase in the other values lasting for the first days of the post-operative period. The causes may be many, such as changes in the oxidation potential, blood transfusions and liver function, and these may be manifested in an increase in the serum glutamic oxalacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase, and gamma-glutamyl transpeptidase.
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Abstract
Pulsatile and nonpulsatile blood flow have been intensely studied for cardiopulmonary bypass (CPB), isolated organ perfusion, and myocardial preservation. Although early studies differed, later ones have shown the benefits of pulsatile flow. Kidney function, lymph flow, and oxygen consumption are increased during pulsatile perfusion. Also, nonpulsatile CPB increases total peripheral resistance and mean arterial pressure, which are related to time of perfusion. Theories to account for the superiority of pulsatile flow include: (1) "vascular shocks" causing physical displacement of tissues, which changes the boundary layer of interstitial fluid around cell membranes and enhances diffusion ;(2) increased lymph movement during pulsatile flow; and (3) pulsatile energy ensuring the patency of the vascular beds and preventing shunting. New methods to create pulsatile flow and their adaptation to the standard roller pump are discussed.
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Oelert H, Eufe R, Borst HG. [Comparison of hemodynamic and metabolic changes in total left heart bypass with pulsatile and non-pulsatile flow. Experimental studies in dogs]. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1973; 159:197-221. [PMID: 4687011 DOI: 10.1007/bf01851546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Moses ML, Camishion RC, Tokunaga K, Pierucci L, Davies AL, Nealon TF. Effect of corticosteroid on the acidosis of prolonged cardiopulmonary bypass. J Surg Res 1966; 6:354-60. [PMID: 5944818 DOI: 10.1016/s0022-4804(66)80051-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Ellison RG, McPherson JC, Yeh TJ, Anabtawi IN, Ellison LT. Metabolic considerations of acid-citrate-dextrose stored blood for extracorporeal circulation. Ann Thorac Surg 1966; 2:540-50. [PMID: 5934069 DOI: 10.1016/s0003-4975(10)66615-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Schweizer O, Howland WS. Significance of lactate and pyruvate according to volume of blood transfusion in man: effect of exogenous bicarbonate buffer on lacticacidemia. Ann Surg 1965; 162:1017-27. [PMID: 5845582 PMCID: PMC1477003 DOI: 10.1097/00000658-196512000-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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RAISON JC. ACID-BASE CHANGES AND TISSUE RESPIRATION IN EXTRACORPOREAL CIRCULATION. Ann R Coll Surg Engl 1965; 37:93-119. [PMID: 14329874 PMCID: PMC2311846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
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FINKLE AL, KARG SJ, SZAKACS JB, SMITH DR. MODIFIED TECHNIC FOR CATHETERIZATION OF RENAL INTERLOBAR VEINS IN DOGS. Ann Surg 1964; 160:1046-8. [PMID: 14246140 PMCID: PMC1408850 DOI: 10.1097/00000658-196412000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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WATERS WC, HALL JD, SCHWARTZ WB. SPONTANEOUS LACTIC ACIDOSIS. THE NATURE OF THE ACID-BASE DISTURBANCE AND CONSIDERATIONS IN DIAGNOSIS AND MANAGEMENT. Am J Med 1963; 35:781-93. [PMID: 14089295 DOI: 10.1016/0002-9343(63)90240-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Connolly JE, Kountz SL, Guernsey JM, Stemmer EA. ACIDOSIS AS A CAUSE OF RENAL SHUTDOWN DURING EXTRACORPOREAL CIRCULATION: ITS CORRECTION BY THE USE OF THAM. J Thorac Cardiovasc Surg 1963. [DOI: 10.1016/s0022-5223(19)33640-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Moore D, Bernhard WF. THE PREVENTION AND TREATMENT OF ACUTE METABOLIC COMPLICATIONS ASSOCIATED WITH PROLONGED EXTRACORPOREAL CIRCULATION. J Thorac Cardiovasc Surg 1963. [DOI: 10.1016/s0022-5223(19)32819-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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LOBPREIS EL, HANNER JM. Cardiac output during cardiopulmonary bypass. Animal experiments as a guide to flow rate. Calif Med 1963; 98:129-33. [PMID: 13931159 PMCID: PMC1575696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Abstract
Superior total body perfusion during cardiopulmonary bypass in dogs is achieved by duplicating, in each individual case, the actual operative cardiac output, rather than by relying on the currently recommended perfusion flow rates.A highly accurate method of measuring the cardiac output is presented using the gated sinewave electromagnetic flowmeter. Simplicity and sensitivity of the method enable the operator to measure the flow in situ (in the intact canine ascending aorta) and thus to determine a truly representative cardiac output before the cardiopulmonary bypass is effected. An adjustable hydraulic pump in conjunction with the electromagnetic flowmeter is used to substitute the natural cardiac action in order to maintain the normal hemodynamic state by providing a pulsatile flow of proper magnitude. The procedure is technically simple and, supported by favorable experimental evidence, is recommended for clinical use in open heart operations.
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GLOVER JL. Metabolic acidosis in extracorporeal circulation. Its prevention and treatment with THAM. Ann Surg 1962; 155:360-9. [PMID: 13899289 PMCID: PMC1466060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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Schramel R, Chapman W, Weiffenbach E, Creech O. TREATMENT OF RESPIRATORY INSUFFICIENCY BY PROLONGED EXTRACORPOREAL CIRCULATION. J Thorac Cardiovasc Surg 1961. [DOI: 10.1016/s0022-5223(19)32548-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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ALBERTAL GA, LUNZER S, LEFMINE A, HARKEN DE, MOORE FK. The effect of the composition of the ventilating gas mixture on acid-base pathways using the disc oxygenator. Am J Surg 1961; 102:444-52. [PMID: 13682115 DOI: 10.1016/0002-9610(61)90534-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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HARDAWAY RM, BARILA TG, BURNS JW, MOCK HP. Studies on pH changes in endotoxin and hemorrhagic shock. J Surg Res 1961; 1:278-84. [PMID: 13904588 DOI: 10.1016/s0022-4804(61)80031-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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NOE FE, PAULI HG, COATES EO, GREIFENSTEIN FE. Individual variations in carbon dioxide balance and ventilatory response. Acta Anaesthesiol Scand 1960; 4:33-49. [PMID: 14427471 DOI: 10.1111/j.1399-6576.1960.tb00061.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dobell AR, Gutelius JR, Murphy DR. Acidosis following respiratory alkalosis in thoracic operations with and without heart-lung bypass. J Thorac Cardiovasc Surg 1960. [DOI: 10.1016/s0022-5223(20)31837-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Magovern GJ, Cartwright RS, Neville JF, Kent EM. METABOLIC ACIDOSIS AND THE DISSOCIATION CURVE OF HEMOGLOBIN DURING EXTRACORPOREAL CIRCULATION. J Thorac Cardiovasc Surg 1959. [DOI: 10.1016/s0022-5223(19)32419-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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