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Biomedical subjects

Bruce D Spiess

Publications and source records attributed to Bruce D Spiess.

24 records · Page 2Linked to original sources
PubMed2003

Current status of antifibrinolytics in cardiopulmonary bypass and elective deep hypothermic circulatory arrest.

Cardiopulmonary bypass (CPB) results in many physiologic derangements, including activation of the hemostatic and fibrinolytic pathways. Deep hypothermic circulatory arrest (DHCA) adds a further insult to the coagulation systems because it involves more extreme hypothermia and organ ischemia related to blood stasis. The abnormalities induced by CPB disrupt the checks and balances in the hemostatic and fibrinolytic systems, resulting in a pathologic state that leads to excessive bleeding and other perioperative complications. Prophylactic antifibrinolytic therapy can attenuate the response to this insult by restoring the delicate balance within these systems, potentially reducing the complication rate and improving patient outcomes.

Animals↗
PubMed2003

An assessment of different filter systems for extracorporeal elimination of bivalirudin: an in vitro study.

IMPLICATIONS: Bivalirudin is a new, direct thrombin inhibitor. We investigated the extracorporeal elimination rate of different hemofilters and one plasmapheresis filter for bivalirudin. Our data show that bivalirudin can be effectively eliminated via hemofiltration and plasmapheresis, although there were significant differences in the elimination rates among the filter systems investigated.

Anticoagulants↗
PubMed2002

Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery.

OBJECTIVE: To compare thoracic electrical bioimpedance (TEB) cardiography versus pulmonary artery thermodilution (TD) derived cardiac index in patients after cardiopulmonary bypass. DESIGN: Prospective, blinded electronic data collection. SETTING: Intensive care unit of a military hospital. PARTICIPANTS: Post-cardiopulmonary bypass patients for primary comparison between technologies (n = 20) and patients for comparison of variability within each technology (n = 20). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cardiac index values by TEB or TD were collected simultaneously. Linear regression, Lin's concordance correlation coefficient, bias, and precision measures within the large data set group and within each patient over time were calculated. Linearity in regression and Lin's concordance correlation coefficient of 0.99 were shown. A bias of 0.07 L/min/m(2) and precision of 0.40 L/min/m(2) were within acceptable clinical limits, as were equivalence test results. CONCLUSIONS: TEB is equivalent to TD-derived cardiac index in postoperative cardiac surgery patients.

Cardiac Output↗
PubMedDate not supplied

Developing a blood conservation program in cardiac surgery.

The beneficial effects of blood transfusions have been described and widely accepted. Multiple factors, including shortages, costs, infectious risks, immunologic risks, and the risk/benefit ratio to the patient, have made the medical community reassess the guidelines for transfusion. Cardiac surgery presents a unique subset of patients, because intervention at multiple stages in the care of these patients is possible to decrease the need for transfusion. An algorithm for a cardiac surgery program was developed and a reassessment performed. Once it was seen that no detrimental effect on patient care occurred, the program was expanded, was enhanced, and subsequently has been offered to the rest of the health care system. This program has resulted in a decrease in cost while maintaining patient outcomes. The success of the program is believed to be a result of the multidisciplinary approach taken, with a commitment from all members of the blood reduction team being the key component of this success.

Aged↗