Biomedical subjects

Joseph Deptula

Publications and source records attributed to Joseph Deptula.

3 recordsLinked to original sources

PubMed2006

Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery.

The contact of blood with nonbiological surfaces during cardiopulmonary bypass (CPB) induces a whole body inflammatory response and increases postoperative morbidity directly related to bleeding complications and end organ dysfunction. Methods to reduce these effects have included modification of extracorporeal circuits through biocompatible coating of disposables and the application of various pharmacological agents. Biocompatible coated surfaces are designed to mimic physiologic surfaces. This study was designed to ascertain the effects of using coated circuits during pediatric CPB. After Institutional Review Board approval and parent/guardian consent, patients undergoing CPB, weighing less than 15 kg, with target CPB temperatures more than 28 degrees C, were enrolled into the Coated Circuit Group using an entirely biocompatible CPB circuit with poly(2-methoxyethylacrylate) (PMEA) and a biocompatible coated oxygenator (n = 16). Those patients were retrospectively matched to control patients having the same congenital repair with respect to patient size, surgeon, anesthesiologist, bypass time, cross-clamp time, bypass temperature, and noncoated bypass disposables; (n = 16). CPB data collected included on-bypass platelet count, hematocrit (HCT), and CPB blood product use. Postprotamine data collected in the operating room included blood product use, time from initial protamine administration to chest closure, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR). Postoperative intensive care unit (ICU) data included blood product use, HCT, chest tube output, platelet count, PT, aPTT, INR, blood gases, lactate, and ventilator settings at 1, 2, 4, 6, 12, and 24 hours. Other data collected included intubation time, length of time to chest tube removal, and length of ICU stay. Statistical significance (p < .05) was seen in units of platelets transfused postprotamine, ventilator peak inflation pressure (PIP) on admission to the ICU, postoperative day 0 packed red blood cells (PRBC) and fresh frozen plasma (FFP) transfused, and lactate at 1, 2, 4, 6, and 12 hours postoperative. Several parameters approached statistical significance, including PRBC transfused postprotamine, time from protamine administration to chest closure, postoperative day 0 platelets transfused, and ICU stay. The data suggest that PMEA biocompatible CPB circuits can be used safely during pediatric heart surgery, resulting in a decrease in postoperative blood product use, improved postoperative lung function, and a reduction in the time spent in the ICU.

Acrylates↗

PubMed2003

Modified ultrafiltration postextracorporeal membrane oxygenation.

Modified ultrafiltration (MUF) has been widely used for the removal of extracellular water in the immediate postcardiopulmonary bypass (CPB) period. The reported benefits of this technique are improved hematological status and hemodynamic stability post-CPB, as well as a decrease in blood utilization during the operation. MUF has also been associated with improved pulmonary status along with enhanced myocardial performance. With these benefits in mind, we have explored the possible advantages of using MUF following extracorporeal membrane oxygenation (ECMO). The theoretical advantages of using MUF post-ECMO are the reduction of blood use prior to removal from ECMO for optimization of hemoglobin levels, improved pulmonary compliance decreasing the duration of ventilatory support, improved myocardial function, as well as the other reported benefits described with MUF post-CPB. This report communicates the technique used to perform MUF post-ECMO, as well as a simple MUF circuit design for use in the intensive care unit setting.

Cardiopulmonary Bypass↗

PubMed2002

Alleviating heat loss associated with modified ultrafiltration.

Modified ultrafiltration (MUF) has been described and utilized for the removal of extracellular water in the immediate postcardiopulmonary bypass (CPB) period. This technique has been associated with improved hematological status and hemodynamic stability post cardiopulmonary bypass. Hypothermia during the MUF period has been described as a complication associated with this technique. Decreased patient temperature may be associated with increased bleeding causing an increase in time to sternal re-approximation, OR time, decreases in cardiac function, peripheral vascular perfusion, and an increase in blood product utilization. These complications may reduce some of the benefits described with the use of MUF. The purpose of this study was to evaluate the use of a heated MUF infusion line to reduce the heat loss associated with this technique in a pediatric population. After obtaining Committee for Protection of Human Subjects exemption, a retrospective review to evaluate the efficiency of the hot MUF infusion line was undertaken. Twenty patients under 10 kg who underwent MUF before the change to a heated infusion line were retrospectively identified and matched to patients undergoing MUF with a heated infusion line with regard to weight, lesion, procedure, surgical staff and technique, and disposable equipment. Groups were evaluated for temperature and hematocrit change during the MUF period, blood loss and transfusion postprotamine in the OR and 24 h, and time to sternal re-approximation postprotamine. Statistical significance was seen between the two groups in temperature (-0.24 +/- 0.72 vs. - 1.58 +/- 0.89 degrees C; p < .0001) with the HotLine group having little change post MUF. Significance was also seen in the last OR temperature recorded (37.0 +/- 1.2 vs. 36.0 +/- 1.0 degrees C; p = .01) with the HotLine group having the higher temperature. There were no significant differences in hematocrit levels at 24 hours, last in the OR, or the change after the MUF period. No significant difference was found in blood transfused postprotamine in the OR, 24-h blood transfused, 24-h chest tube loss, or sternal closure. The study suggests that the use of a heated MUF infusion line safely reduces the heat loss associated with MUF in the immediate post-operative period.

Body Temperature Regulation↗