Japanese Journal of Extra-Corporeal Technology
Online ISSN : 1884-5452
Print ISSN : 0912-2664
ISSN-L : 0912-2664
Volume 46 , Issue 2
Showing 1-4 articles out of 4 articles from the selected issue
Original Articles
  • Atsushi Nakamura, Masahiro Kikuta
    2019 Volume 46 Issue 2 Pages 119-124
    Published: 2019
    Released: July 03, 2019
    JOURNALS FREE ACCESS

    Microbubbles inside a cardiopulmonary bypass circuit are captured by a venous reservoir or by the artificial lung, and ultimately, an arterial line filter (ALF) prevents gaseous micro-emboli (GME) from getting injected into the patient’s body. In our study using ALFs with pore sizes of 40 μm (PS40) and 20 μm (PS20), bubbles with a mean bubble diameter of 50 μm, 100 μm, and 180 μm were injected into the ALF. Arterial line filter GME removal was examined using different bubble sizes.

    In the bubble group with various bubble sizes, the number of bubbles and the rate of bubble removal were determined for 50 μm bubbles (PS40=44.5±0.7%, PS20=56.1±0.6%, P<0.001), 100 μm bubbles (PS40=13.7±1.9%, PS20=9.9±3.8%, P=0.205), and 180 μm bubbles (PS40=-7.0±1.5%, PS20=-29.3±1.8%, P<0.001). Air bubble shrinkage and bubble volume removal rates were significantly higher with PS20.

    The bubble’s internal pressure becomes lower as the bubble size is larger, which suggests that air bubbles can easily change shape and disrupt. This suggests that GME removal capability increases when all microbubbles that flow into the ALF are maintained at a diameter of 40-50 μm or less.

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  • Atsushi Nakamura, Masahiro Kikuta
    2019 Volume 46 Issue 2 Pages 125-130
    Published: 2019
    Released: July 03, 2019
    JOURNALS FREE ACCESS

    Microbubbles inside a cardiopulmonary bypass circuit are captured by a venous reservoir or by the artificial lung, and ultimately, an arterial line filter (ALF) prevents gaseous micro-emboli (GME) from getting injected into the patient’s body. In our study using ALFs with pore sizes of 40 μm (PS40) and 20 μm (PS20), bubbles with a mean bubble diameter of 50 μm, 100 μm, and 180 μm were injected into the ALF. Arterial line filter GME removal was examined using different bubble sizes.

    In the bubble group with various bubble sizes, the number of bubbles and the rate of bubble removal were determined for 50 μm bubbles (PS40=44.5±0.7%, PS20=56.1±0.4%, P>0.001), 100 μm bubbles (PS40=13.7±1.9%, PS20=9.9±3.8%, P=0.205), and 180 μm bubbles (PS40=-7.0±1.5%, PS20=-29.3±1.8%, P<0.001). Air bubble shrinkage and bubble volume removal rates were significantly higher with PS20.

    The bubble’s internal pressure becomes lower as the bubble size is larger, which suggests that air bubbles can easily change shape and disrupt. This suggests that GME removal capability increases when all microbubbles that flow into the ALF are maintained at a diameter of 40-50μm or less.

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  • Kazuyuki Nagata, Kosuke Nakajima, Arudo Hiraoka, Masahisa Arimichi, To ...
    2019 Volume 46 Issue 2 Pages 131-138
    Published: 2019
    Released: July 03, 2019
    JOURNALS FREE ACCESS

    [Background] Various causes of postoperative cognitive dysfunction (POCD) following cardiac surgery have been speculated, including a previous report that found use of a heart-lung machine to be a causative factor.

    [Methods] We investigated 160 consecutive patients who underwent a heart valve operation with a cardiopulmonary bypass, and received 4 different types of pre- and postoperative recognition function tests. Those who showed a greater than 20% reduction in postoperative test values or experienced difficulty with the assessments following surgery were judged to be POCD. Factors related to POCD occurrence were then evaluated using multivariate analysis.

    [Results] POCD occurred in 49 cases (30.6%). Comparisons between the onset and non-onset groups revealed that patients with onset were significantly older, while many of those had a medical history of cognitive impairment and blood symptoms, as well as higher HbA1c values. The onset group also had a significantly shorter rewarming time during cardiopulmonary bypass, and significantly lower perfusion index (PI), hemoglobin, and oxygen delivery (DO2i) values during rewarming. During the postoperative course, the onset group had a significantly higher creatinine value, greater rate of increase in postoperative serum creatinine, longer intubation time, and longer length of ICU or hospital stay. Multivariate analysis showed age (cut-off value 72 years, AUC 0.71, OR 6.09, CI 2.40-15.5; P=0.0021) and DO2i during rewarming at 35°C (cut-off value 276mL/min/m2, AUC 0.79, OR 9.28, CI 4.22-20.4; P<0.0001) as independent risk factors for POCD occurrence.

    [Discussion] POCD following cardiac surgery results not only in a decline of cognitive capacity, but also has a negative influence on the postoperative course. Notably, for effective cardiopulmonary bypass management in elderly patients, maintaining an adequate DO2i value during rewarming is important.

    [Conclusion] Both age and DO2i during the rewarming period following a cardiopulmonary bypass were found to be factors related to POCD occurrence in cardiac surgery patients.

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