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Item Information   Holdings       More by this author     Warhoover, Matthew T.     Subjects     Cardiopulmonary bypass -- Adverse effects     Blood -- Circulation, Artificial     Extracorporeal Circulation -- methods     Inflammation Mediators.     MSP Thesis.     Browse Catalog     by author:      Warhoover, Matthew T.       by title:      Determination of the...         MARC Display

Determination of the effects of two intra-operative blood conservation techniques (cardiotomy reservoir versus cell-saver) on systemic inflammatory response when augmented by leukocyte filtration : a pilot study / Matthew T. Warhoover. by Warhoover, Matthew T. Subjects Cardiopulmonary bypass -- Adverse effects   Blood -- Circulation, Artificial   Extracorporeal Circulation -- methods   Inflammation Mediators.   MSP Thesis. Description:  79 leaves : ill. ; 29 cm. Contents:  Committee members: Dr. Ronald Gerrits, Dr. Charles Tritt, Dr. Larry Fennigkoh. Introduction -- Problem and objective -- Background -- Purpose -- Hypotheses -- Materials and methods -- Results -- Discussion -- Conclusion and recommendations. Background: In cardiac surgery utilizing cardiopulmonary bypass (CPB) there is significant blood loss due to surgical incision and the use of anticoagulants. This volume is returned systemically to the patient by means of cardiotomy suction. However, returning this shed blood, which contains numerous inflammatory mediators, results in a "whole body inflammatory response" that contributes to multi organ failure, diffuse tissue edema, and pathological hypotension. By utilizing a cell-saver, which filters the inflammatory mediators from the shed blood, as the only means for autologous blood salvaging, this "whole body inflammatory response" may be minimized improving patient outcomes. Purpose: This pilot study was undertaken to examine the effect of different intraoperative blood salvage techniques on peri- and post-operative inflammatory response, and to determine if utilizing a blood processing device (cell-saver) for retrieval of shed blood is an effective tool to minimize overall inflammatory response during cardiac surgery. Methods: Using the same surgeon, a blinded study on 12 patients undergoing first time coronary artery bypass grafting with the use of CPB was performed. Patients were randomly assigned pre-operatively to either a control group, utilizing traditional cardiotomy suction or a study group, utilizing only a cell-saver for salvaging shed blood. CPB, except for the use of cardiotomy suction, and anesthetic techniques were standardized for all patients. Inflammation was determined by pre-, peri-, and post-operative levels of terminal complement complex (TCC) and white blood cell counts. In addition, cardiac indexes were also calculated pre-, peri- and post-operatively as a clinical parameter to measure inflammation. Results: Patients in the control group experienced higher TCC levels at all time intervals than the study group, and at the 15 minute post-CPB time interval, patients in the control group experienced significantly higher TCC levels than the study group. Furthermore, 33% of the patients in the control group needed inotropic support immediately following the termination of CPB, whereas no patients in the study group required pharmacological intervention. In addition 8 hour post-operative cardiac indexes increased 31% from pre-operative calculations in the study group, while the cardiac indexes of the control group increased only 16% without inotropic support and 24% with inotropic support within the same time periods. Conclusion: These data suggest that utilizing a cell-saver decreases the degree of "whole body inflammation." However, only at the 15 minute post-CPB time interval did statistical significance differences occur in TCC levels. Thus, this study does not conclusively show that traditional cardiotomy suction generated a higher inflammatory response than the use of a cell-saver for salvaging shed blood. However, with the trending data of this study suggesting greater inflammatory response with the use of traditional pump suction, further investigation with a larger patient sample size is warranted for conclusive determination of the difference, if any between the use of traditional cardiotomy suction and a cell-saver for salvaging intra-operative shed blood.   Copy/Holding information Location Collection Call No. Status   Walter Schroeder Library Master's Theses AC805 .W37 2002 Available Add Copy to MyList Format: HTMLPlain textDelimited Subject:   Email to:

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