| Efficacy of a criterion-driven transfusion protocol in patients having pediatric cardiac surgery. | |
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MedLine Citation:
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PMID: 15052189 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Low-hematocrit bypass is one technique used to prevent allogeneic transfusion during cardiopulmonary bypass. The purpose of this study is to determine the efficacy of a criterion-driven transfusion protocol and the effect of low-hematocrit bypass with moderate hypothermia in pediatric cardiac surgery. METHODS: Seventy-five children who underwent cardiopulmonary bypass with low-hematocrit bypass for repair of congenital heart disease were studied. Criteria for red blood cell transfusion included anemia with a hematocrit level of less than 15% during bypass and 20% after bypass. During cardiopulmonary bypass, venous oxygen saturation, hematocrit values, and regional cerebral oxygenation were continuously monitored. Arterial lactate levels were measured postoperatively. RESULTS: All patients had an uncomplicated perioperative course, and no perioperative death occurred. Twenty-two patients (29.3%) received a transfusion, and 53 (70.7%) patients did not. The hematocrit levels before and after modified ultrafiltration in the transfused group (21.6 +/- 5.5%, 26.6 +/- 6.5%) were significantly higher than those in the nontransfused group (18.9 +/- 3.7%, 23.1 +/- 4.1%) (P <.05). There was no significant difference between the group's arterial lactate levels immediately after admission to the intensive care unit and 1 day after the operation. The arterial lactate levels 6 hours after the admission to the intensive care unit for the nontransfused patients were higher than with the transfused patients (4.3 +/- 3.0 versus 2.5 +/- 1.5 mmol/L, (P <.05). For arterial lactate level, the relation with patients' weight had the highest correlation (R = 0.678, P <.0001). CONCLUSIONS: A criterion-driven transfusion program can be effective, and low-hematocrit bypass with a hematocrit value below 20% may affect lactate production or clearance from the body. |
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Authors:
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Yoshio Ootaki; Masahiro Yamaguchi; Naoki Yoshimura; Shigeteru Oka; Masahiro Yoshida; Tomomi Hasegawa |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 127 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2004 Apr |
Date Detail:
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Created Date: 2004-03-30 Completed Date: 2004-06-15 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 953-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiothoracic Surgery, Kobe Children's Hospital, Hyogo, Japan. y.ootaki@nifty.ne.jp |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Biological Markers / blood Body Temperature Body Weight Cardiac Surgical Procedures* Cardiopulmonary Bypass Child Child Welfare Child, Preschool Erythrocyte Transfusion* Female Heart Defects, Congenital / blood, therapy Hematocrit Humans Hypothermia, Induced Infant Infant Welfare Intensive Care Units, Pediatric Japan Lactic Acid / metabolism Male Oxygen / blood Prospective Studies Statistics as Topic Treatment Outcome Ultrafiltration |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 50-21-5/Lactic Acid; 7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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J Thorac Cardiovasc Surg. 2005 May;129(5):1200; author reply 1201-2
[PMID:
15867817
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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