The Application Effect of Predictive Nursing on Cardiopulmonary Rehabilitation of Patients Undergoing Heart Valve Surgery with Extracorporeal Circulation

Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.

Impact and Management under Extracorporeal Circulation of a Patient with Renal Insufficiency on Dialysis with a High-Flow Arteriovenous Fistula in the Cardiac Surgery Department of the Angers Teaching Hospital about a Case and Review of the Literature

Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.

Hyperbilirubinemia after extracorporeal circulation surgery:A recent and prospective study

AIM： To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated mortality and morbidity. METHODS： Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters were compared by logistic regression between hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality. RESULTS： Overall incidence of postoperative hyperbilirubinemia was 25.3% （98/386）. In patients with postoperative hyperbilirubinemia, 56.2% reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3% on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality （P 〈 0.01）, longer duration of mechanical ventilation （P 〈 0.05） and longer ICU stay time （P 〈 0.05）. Preoperative total bilirubin concentration, preoperative right atrium pressure, numbers of valves replaced and of blood transfusion requirement were identified as important predictors for postoperative hyperbUirubinemia. CONCLUSION： Early postoperative hyperbilirubinemia after modern extracorporeal circulation is mainly caused by an increase in both conjugated and unconjugated bilirubin, and is associated with a high mortality. Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial pressure, numbers of valve replacement procedures, and the amount of blood transfusion requirement during and shortly after surgery. We suggest that postoperative hyperbilirubinemia is a multifactorial process, which is caused by,both the impaired liver function of bilirubin transport and the increased production of bilirubin from haemolysis.

Is there a role of TNFR1 in acute lung injury cases associated with extracorporeal circulation？

The signaling pathway for tumor necrosis factor-a （TNF-a） and its receptors is up-regulated during ex- tracorporeal circulation （ECC）, and recruits blood neutrophil into the lung tissue, which results in acute lung injury （ALl） In this study, we evaluated the role of tumor necrosis factor receptor I （TNFR1） in ECC-induced ALl by blocking TNF-a binding to TNFR1 with CAY10500. Anesthetized Sprague-Dawley （SD） rats were pretreated intravenously with phos- phate buffered saline （PBS） or vehicle （0.3 ml ethanol IV） or CAY10500, and then underwent ECC for 2 h. The oxy- genation index （OI） and pulmonary inflammation were assessed after ECC. OI was significantly decreased, while TNF-a and neutrophil in bronchoalveolar lavage fluid （BALF） and plasma TNF-a increased after ECC. Pretreatment of CAY10500 decreased plasma TNF-a level, but did not decrease TNF-a levels and neutrophil counts in BALF or improve OI. Lung histopathology showed significant alveolar congestion, infiltration of the leukocytes in the airspace, and increased thickness of the alveolar wall in all ECC-treated groups. CAY10500 pretreatment slightly reduced leukocyte infiltration in lungs, but did not change the wet/dry ratio in the lung tissue. Blocking TNF-a binding to TNFR1 by CAY10500 intravenously slightly mitigates pulmonary inflammation, but cannot improve the pulmonary function, indicating the limited role of TNFR1 pathway in circulating inflammatory cell in ECC-induced ALl.

Case Reports:Anesthetic management of emergent critical tracheal stenosis

Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circu-lation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.

A good resuscitation model of non-transthoracic cardiopulmonary bypass in rats

Objective： To establish a good recoverable rat model of cardiopulmonary bypass （CPB） to lay the foundation for studying the pathophysiology of CPB. Methods： Twenty adult male Sprague-Dawley rats weighing 480 g ±20 g were randomly divided into CPB group （n = 10 ） and Sham group （ n = 10 ）. All rats were anaesthetized, intubated and ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular vein and further transferred by a miniaturized roller pump to a hollow fiber oxgenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 6 ml of colloid. The surface of the hollow fiber oxgenator was 0.075 m^2. Rats were catheterized and brought in bypass for 120 rain at a flow rate of 100-120 ml/kg/min. Oxygen flow/ perfnsion flow was 0.8 to 1.0, the mean arterial pressure （MAP） kept in 60-80 mmHg. Blood gas analysis, lactate dehydrogenase （LDH）, and survival rate were examined subsequently. Results： AH CPB rats recovered from the operative process without incident and remained uneventful within one week. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. MAP remained stable. The results of blood gas analysis at different time points were within a normal range. No significant haemolysis could be detected in the given time frame under bypass condition by using LDH. Conclusions： The rat model of CPB can principally simulate the clinical setting of human CPB. The nontrausthoracic model is easy to establish and is associated with excellent recovery. This well reproducible model may open the field for various studies on pathophysiological process of CPB and also of systemic ischemia-reperfusion injury in vivo.