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A new de-airing technique that reduces systemic microemboli during open surgery: a prospective controlled study.

Al-Rashidi, Faleh; Blomquist, Sten LU ; Höglund, Peter LU ; Meurling, Carl LU ; Roijer, Anders LU and Koul, Bansi LU (2009) In The Journal of thoracic and cardiovascular surgery 138(1). p.157-162
Abstract
OBJECTIVE: We have evaluated a new technique of cardiac de-airing that is aimed at a) minimizing air from entering into the pulmonary veins by opening both pleurae and allowing lungs to collapse and b) flushing out residual air from the lungs by staged cardiac filling and lung ventilation. These air emboli are usually trapped in the pulmonary veins and may lead to ventricular dysfunction, life-threatening arrhythmias, and transient or permanent neurologic deficits. METHODS: Twenty patients undergoing elective true left open surgery were prospectively and alternately enrolled in the study to the conventional de-airing technique (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass [control group]) and the new... (More)
OBJECTIVE: We have evaluated a new technique of cardiac de-airing that is aimed at a) minimizing air from entering into the pulmonary veins by opening both pleurae and allowing lungs to collapse and b) flushing out residual air from the lungs by staged cardiac filling and lung ventilation. These air emboli are usually trapped in the pulmonary veins and may lead to ventricular dysfunction, life-threatening arrhythmias, and transient or permanent neurologic deficits. METHODS: Twenty patients undergoing elective true left open surgery were prospectively and alternately enrolled in the study to the conventional de-airing technique (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass [control group]) and the new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion, and ventilation of lungs during de-airing [study group]). Transesophageal echocardiography and transcranial Doppler continually monitored the air emboli during the de-airing period and for 10 minutes after termination of the cardiopulmonary bypass. RESULTS: The amount of air embolism as observed on echocardiography and the number of microembolic signals as recorded by transcranial Doppler were significantly less in the study group during the de-airing time (P < .001) and the first 10 minutes after termination of cardiopulmonary bypass (P < .001). Further, the de-airing time was significantly shorter in the study group (10 vs 17 minutes, P < .001). CONCLUSION: The de-airing technique evaluated in this study is simple, reproducible, controlled, safe, and effective. Moreover, it is cost-effective because the de-airing time is short and no extra expenses are involved. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Embolism, Air: prevention & control, Air: ultrasonography, Cardiac Surgical Procedures: adverse effects, Cardiac Surgical Procedures: methods
in
The Journal of thoracic and cardiovascular surgery
volume
138
issue
1
pages
157 - 162
publisher
Mosby
external identifiers
  • WOS:000267695400025
  • PMID:19577073
  • Scopus:67649406069
ISSN
1097-685X
DOI
10.1016/j.jtcvs.2009.02.037
language
English
LU publication?
yes
id
e0155892-adf1-4e81-b5df-31e028d9401f (old id 1453406)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19577073?dopt=Abstract
date added to LUP
2009-08-04 10:33:45
date last changed
2016-10-13 04:31:25
@misc{e0155892-adf1-4e81-b5df-31e028d9401f,
  abstract     = {OBJECTIVE: We have evaluated a new technique of cardiac de-airing that is aimed at a) minimizing air from entering into the pulmonary veins by opening both pleurae and allowing lungs to collapse and b) flushing out residual air from the lungs by staged cardiac filling and lung ventilation. These air emboli are usually trapped in the pulmonary veins and may lead to ventricular dysfunction, life-threatening arrhythmias, and transient or permanent neurologic deficits. METHODS: Twenty patients undergoing elective true left open surgery were prospectively and alternately enrolled in the study to the conventional de-airing technique (pleural cavities unopened, dead space ventilation during cardiopulmonary bypass [control group]) and the new de-airing technique (pleural cavities open, ventilator disconnected during cardiopulmonary bypass, staged perfusion, and ventilation of lungs during de-airing [study group]). Transesophageal echocardiography and transcranial Doppler continually monitored the air emboli during the de-airing period and for 10 minutes after termination of the cardiopulmonary bypass. RESULTS: The amount of air embolism as observed on echocardiography and the number of microembolic signals as recorded by transcranial Doppler were significantly less in the study group during the de-airing time (P &lt; .001) and the first 10 minutes after termination of cardiopulmonary bypass (P &lt; .001). Further, the de-airing time was significantly shorter in the study group (10 vs 17 minutes, P &lt; .001). CONCLUSION: The de-airing technique evaluated in this study is simple, reproducible, controlled, safe, and effective. Moreover, it is cost-effective because the de-airing time is short and no extra expenses are involved.},
  author       = {Al-Rashidi, Faleh and Blomquist, Sten and Höglund, Peter and Meurling, Carl and Roijer, Anders and Koul, Bansi},
  issn         = {1097-685X},
  keyword      = {Embolism,Air: prevention & control,Air: ultrasonography,Cardiac Surgical Procedures: adverse effects,Cardiac Surgical Procedures: methods},
  language     = {eng},
  number       = {1},
  pages        = {157--162},
  publisher    = {ARRAY(0xa32f600)},
  series       = {The Journal of thoracic and cardiovascular surgery},
  title        = {A new de-airing technique that reduces systemic microemboli during open surgery: a prospective controlled study.},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2009.02.037},
  volume       = {138},
  year         = {2009},
}