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  • 1
    Electronic Resource
    Electronic Resource
    Gastrointestinal permeability following cardiopulmonary bypass: a randomised study comparing the effects of dopamine and dopexamine (1997)
    Springer
    Intensive care medicine 23 (1997), S. 510-516 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiopulmonary bypass ; Gastrointestinal permeability ; Dopexamine ; Dopamine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To compare the effects of dopexamine and dopamine on the mucosal permeability of the gastrointestinal tract (GIT). Design: Prospective, randomised clinical trial. Setting: Intensive care unit of a postgraduate teaching hospital, London, England. Patients: Thirty patients undergoing elective surgery involving cardiopulmonary bypass, performed by a single surgeon. Interventions: Patients were randomly assigned to receive either dopexamine 2.0 μg/kg per min or dopamine 2.5 μg/kg per min for the duration of the study period. Measurements and main results: Hemodynamic parameters and gastric intramucosal pH (pHi) were measured at intervals throughout the study. GIT permeability was measured once, post-operatively, using the ratio of absorbed lactulose to L-rhamnose. The groups were similar with respect to demographics, pre- and post-operative risk factors. The lactulose/rhamnose ratio was (mean ± SEM) 0.44 ± 0.10 in the dopexamine group vs 0.65 ± 0.08 in that receiving dopamine (p 〈 0.05). The dopexamine group had a significantly higher oxygen delivery preoperatively (479.5 ± 32.0 ml/min per m2 vs 344.4 ± 23.9 ml/min per m2 for dopamine, p 〈 0.01), but no other significant differences emerged between the groups. Conclusions: Compared to dopamine, dopexamine reduces GIT permeability following surgery involving cardiopulmonary bypass. The mechanism of this effect remains unclear.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050366
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  • 2
    Electronic Resource
    Electronic Resource
    Acute renal failure following cardiopulmonary bypass: a changing picture (2000)
    Springer
    Intensive care medicine 26 (2000), S. 565-571 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiopulmonary bypass ; Acute renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the incidence of acute renal failure (ARF) developing perioperatively in adult patients requiring cardiopulmonary bypass surgery (CPB) and to make comparisons with data from the same institution published earlier. Design: Prospective, observational. Setting: Tertiary referral centre for cardiopulmonary medicine. Patients and participants: All patients admitted to the intensive care unit (ICU) who developed ARF perioperatively necessitating continuous veno-venous haemofiltration (CVVH) during the 24 months January 1997–December 1998. Interventions: None. Measurements and results: Of 2337 adult patients undergoing cardiac surgery, 47 (2.0 %) needed CVVH. Patients were excluded from analysis who underwent cardiac transplantation (n = 4), pericardial surgery (n = 3) or insertion of a left ventricular assist device (n = 1). Of the remaining 39, 21 patients died in ICU (53.8 % mortality). Relatively more non-survivors suffered from diabetes, hypertension and preoperative renal dysfunction. A previous report from our Unit revealed that, in 1989–90, 2.7 % of all patients undergoing CPB required CVVH with an in-hospital mortality of 83 %. The current study population were older (65.3 vs 56.0 years in 1990), and more severely ill as evidenced by a higher percentage of patients requiring redo (30 % vs 8.6 % in 1990) and emergency (50 % vs 25.7 % in 1990) surgery. Conclusions: The need for CVVH following CPB may be diminishing despite increased risk factors. ARF-associated mortality in these circumstances is falling.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051205
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  • 3
    Electronic Resource
    Electronic Resource
    Continuous veno-venous haemofiltration following cardio-pulmonary bypass (1993)
    Springer
    Intensive care medicine 19 (1993), S. 290-293 
    Details
    ISSN: 1432-1238
    Keywords: Acute renal failure ; Cardio-pulmonary bypass ; Haemofiltration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To study the impact of continuous veno-venous haemofiltration on survival in patients with acute renal failure (ARF) following cardio-pulmonary bypass (CPB) surgery. Design A retrospective study of all patients requiring haemofiltration after CPB over a 2 year period. Setting A 20 bedded, adult cardothoracic intensive care unit in a postgraduate teaching hospital. Patients 35 patients (26 male, age range 24–74 years) required haemofiltration (2.7% of the total number of patients undergoing CPB). Main results Cardiovascular failure post CPB was the commonest causes of ARF (n=16). Indications for haemofiltration were ureamia (21), oligo-anuria (11), volume overload (2) and hyperkalaemia (1). Mean time from CPB to the initiation of haemofiltration was 8 days (range 0–15 days). Mean urea was 30 mmol/l and creatinine 362 μmol/l immediately prior to treatment. Urea was well-controlled in all patients, although 2 needed haemodiafiltration. Twenty-six patients died during their admission to the ICU (74% mortality). A further 3 patients died during their hospital admission, following discharge from ICU. Outcome was particularly poor in patients with cardiovascular failure following CPB (16 cases, 0 survivors). Survivors tended to commence filtration earlier (mean of 4 vs 7 days for non-survivors) and required treatment for a mean period of 8 days (range 1–26 days). Survival was determined by the number of failed organ systems at the start of haemofiltration. Thus, 100% of patients with single system failure survived, compared to only 10% with 3 or more system failure. Conclusions Despite the theoretical advantages of haemofiltration and the effective control of uraemia the mortality associated with ARF following CPB remains high and is probably determined by the number of failed organs systems.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01690550
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    Paper (German National Licenses)
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