Serdar GÜNAYDIN, Murat BOZ, Zekeriya TELLİ, Tayyar SARIOĞLU, Yusuf Kenan YALÇINBAŞ

Spectrum Medical M3 monitörünün pediyatrik kalp cerrrahisinde kullanımı: Capiox RX05 ve Capiox FX05 oksijenatörlerinde gaz embolisinin monitörizasyonu

Amaç: Spectrum Medical M3 monitörünün klinik kullanımıyla birlikte arteriyel filtresiz Terumo Capiox RX05 ve entegre arteriyel filtreli Capiox FX05 oksijenatörlerde emboli monitörizasyonunun sonuçları incelendi.Çalışma planı: Spectrum Medical M3 monitörü Aralık 2010 ve Haziran 2011 tarihleri arasında 50 hastada kullanıldı. Otuz hastada (grup 1; 21 erkek, 9 kız; ort yaş 26.3±12.4 ay) Capiox RX05, 20 hastada (group 2; 10 erkek, 10 kız; ort. yaş 22.4±12 ay) Capiox FX05 oksijenatörü kullanıldı. Ortalama yaş grup 1'de 26.3±12.4 ay, grup 2'de 22.4±12 ay idi. Heparin dozu 400 ünite/kg idi. Etkinleştirilmiş pıhtılaşma zamanı >500 saniyede, hematokrit %25-30 arasında ve kardiyopulmoner baypas debisi 125-150/mL/kg/dakikada korundu. Orta dereceli hipotermi (28-34 derece), alfa stat kan gazı yönetimi ve antegrad izotermik kan kardiyoplejisi kullanıldı.Bul gu lar: Grup 1'de mortalite gözlenmedi. Grup 2'de bir hasta pulmoner hipertansiyon nedeni ile öldü. Grup 1 ve grup 2'de iki hastada pnömoni nedeni ile uzun süreli solunum desteği gerekti. Grup 1'de arteriyel gaz embolisi sayısı ortalama 32573 (2306360051) (%25-75 persentil), ortalama gaz embolisi volümü 4.2 mL (2.1-7.5 mL) (%25-75 persentil) idi. Grup 2'de arteriyel gaz embolisi sayısı ortalama 25053 (9096.3-37352.3) (%25-75 persentil), ortalama gaz embolisi volümü 1.1 mL (0.5-3.2 mL) (%25-75 persentil) (Arteriyel emboli sayısı için p değeri 0.043, arteriyel emboli volümü için p değeri 0.001) idi.So nuç: Spectrum Medical M3 monitörü pediyatrik kalp cerrahisinde gaz embolisi monitörizasyonu için faydalı bir cihazdır. Gaz embolisinden korunmada entegre arteriyel filtreli Terumo FX05 oksijenatör, arteriyel filtresi olmayan Capiox RX05 oksijenatörden daha etkili olabilir.

Use of Spectrum Medical M3 monitor in pediatric cardiac surgery: gaseous emboli monitoring in Capiox RX05 and Capiox FX05 oxygenators

Background: The clinical use of Spectrum Medical M3 monitor, and the results of emboli monitoring for Terumo Capiox RX05 oxygenator without arterial filter and Terumo Capiox FX05 oxygenator with built in arterial filter were evaluated. Methods: Spectrum Medical M3 monitor was used for 50 patients between December 2010 and June 2011. Capiox RX05 oxygenator was used for 30 patients (group 1; 21 boys, 9 girls; mean age 26.3±12.4 months), and Capiox FX05 oxygenator was used for 20 patients (group 2; 10 boys, 10 girls; mean age 22.4±12 months). Heparin dose was 400 units/kg. Activated clotting time was maintained at >500 seconds, hematocrit was maintained at 25-30%, and cardiopulmonary bypass flow was maintained at 125-150 mL/kg/minute. Moderate hypothermia (28- 34 degrees), alfa stat blood gas management, and antegrade isothermic blood cardioplegia were used. Results: No mortality was observed in group 1. In group 2, one patient died due to pulmonary hypertension. Two patients needed prolonged respiratory support for pneumonia in group 1 and group 2. In group 1, the mean number of arterial gaseous emboli was 32573(25-75% percentile), and mean volume of arterial gaseous emboli was 4.2 mL (2.1-7.5 mL) (25-75% percentile). In group 2, the mean number of arterial gaseous emboli was 25053 (9096.3-37352.3) (25-75% percentile), and mean volume of arterial gaseous emboli was 1.1 mL (0.5-3.2 mL) (25-75% percentile) (p value for the number of arterial emboli was 0.043, and p value for arterial emboli volume was 0.001). Conclusion: Spectrum Medical M3 monitor is a useful device for monitoring gaseous emboli in pediatric cardiac surgery. Terumo Capiox FX05 oxygenator with built in arterial filter may be more effective for the prevention of gaseous emboli than Terumo Capiox RX05 oxygenator without arterial filter.

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1. Win KN, Wang S, Undar A. Microemboli generation, detection and characterization during CPB procedures in neonates, infants, and small children. ASAIO J. 2008;54:486-90.
2. Williams GD, Ramamoorthy C. Brain monitoring and protection during pediatric cardiac surgery. Semin Cardiothorac Vasc Anesth. 2007;11:23-33.
3. Wang S, Woitas K, Clark JB, Myers JL, Undar A. Clinical real-time monitoring of gaseous microemboli in pediatric cardiopulmonary bypass. Artif Organs. 2009;33:1026-30.
4. Bailey DH, da Silva EJ, Clutton-Brock TH. In vitro performance of a new non-invasive extracorporeal saturation monitor. Anaesthesia 2011;66:889-94.
5. Yee S, Qiu F, Su X, Rider A, Kunselman AR, Guan Y, Undar A. Evaluation of HL-20 roller pump and Rotaflow centrifugal pump on perfusion quality and gaseous microemboli delivery. Artif Organs 2010;34:937-43.
6. Wang S, Kunselman AR, Myers JL, Undar A. Comparison of two different blood pumps on delivery of gaseous microemboli during pulsatile and nonpulsatile perfusion in a simulated infant CPB model. ASAIO J 2008;54:538-41.
7. Dogal NM, Mathis RK, Lin J, Qiu F, Kunselman A, Undar A. Evaluation of three hollow-fiber membrane oxygenators without integrated arterial filters for neonatal cardiopulmonary bypass. Perfusion 2012 ;27:132-40
8. Nuszkowski MM, Deutsch N, Jonas RA, Zurakowski D, Montague E, Holt DW. Randomized trial of the Terumo Capiox FX05 oxygenator with integral arterial filter versus Terumo Capiox Baby RX05 and Terumo Capiox AF02 arterial filter in infants undergoing cardiopulmonary bypass. J Extra Corpor Technol 2011;43:207-14.
9. Deptula JJ, Fogg SK, Glogowski KR, Fenton KN, Duncan KF. Extended support with the Terumo Baby-RX oxygenator. J Extra Corpor Technol 2004;36:364-7.
10. Salavitabar A, Qiu F, Kunselman A, Ündar A. Evaluation of the Quadrox-I neonatal oxygenator with an integrated arterial filter. Perfusion 2010 ;25:409-15.
11. Lin J, Dogal N, Mathis R, Qiu F, Kunselman A, Undar A. Evaluation of Quadrox-I and Capiox FX neonatal oxygenators with integrated arterial filters in eliminating gaseous microemboli and retaining hemodynamic properties during simulated cardiopulmonary bypass. Perfusion 2012;27:235-43.
12. Horton SB, Donath S, Thuys CA, Bennett MJ, Augustin SL, Horton AM, et al. Integrated oxygenator FX05. ASAIO J 2011;57:522-6.
13. Gomez D, Preston TJ, Olshove VF, Phillips AB, Galantowicz ME. Evaluation of air handling in a new generation neonatal oxygenator with integral arterial filter. Perfusion 2009;24:107-12.
14. Deptula J, Valleley M, Glogowski K, Detwiler J, Hammel J, Duncan K. Clinical evaluation of the Terumo Capiox FX05 hollow fiber oxygenator with integrated arterial line filter. J Extra Corpor Technol 2009;4:220-5.
15. Qiu F, Peng S, Kunselman A, Ündar A. Evaluation of Capiox FX05 oxygenator with an integrated arterial filter on trapping gaseous microemboli and pressure drop with open and closed purge line. Artif Organs 2010;34:1053-7.