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Biomedical subjects

B Biagioli

Publications and source records attributed to B Biagioli.

12 recordsLinked to original sources
PubMed1992

Epicardial damage induced by topical cooling during paediatric cardiac surgery.

OBJECTIVE: To study electrocardiographic changes in infants and children in whom topical cooling was used during surgical repair of congenital heart defects. DESIGN: A retrospective study of all patients who had surgical repair of congenital heart disease during cold blood cardioplegia and topical cooling from January to August 1990. Eleven patients (group 1) had topical cooling with ice and 15 (group 2) with cold saline. PATIENTS: All 36 paediatric patients operated on during this period. All the available electrocardiographic records were analysed. Ten patients in whom reliable records were not available were excluded. Twenty six patients entered in this retrospective study. INTERVENTIONS: Topical cooling with ice or with a slush of cold saline. MAIN OUTCOME MEASURE: Recordings from all the precordial leads were examined and scored as the sum of the maximum ST elevation (mV) in each precordial lead. The score obtained for each electrocardiogram was recorded together with the timing of the electrocardiogram (preoperative, arrival in intensive care unit immediately after surgery, postoperatively in the intensive care unit, and at discharge). RESULTS: There were no differences between the two groups in terms of demographic data, diagnosis, duration of ischaemia, and postoperative myocardial performance. There was temporary ST elevation during the first 48 postoperative hours in all the children in group 1 but in only seven of the 15 children in group 2 (Fisher's test, p less than 0.005). The mean (SD) score for maximum ST elevation was 1.34 (0.83) mV in group 1 and 0.52 (0.64) mV in group 2 (Student's t test, p less than 0.01). CONCLUSIONS: These temporary electrocardiographic changes in the presence of adequate myocardial performance were attributed to epicardial damage induced by hypothermicosmotic injury. The use of ice for topical cooling may damage the epicardium in children.

Adolescent↗
PubMed1991

[Continuous blood gas monitoring in intensive care units].

The measurement of O2 and CO2 transport in the arterial and venous mixed blood constitutes the intersection between haemodynamic data and expiratory-inspiratory gases. The arterial-venous difference in O2 (a-v-DO2) and the venous arterial difference in CO2 (v-a-DCO2) calculated from the data of PA, PO2, PCO2 (read by an ABL4 Radiometer) revealed a close correlation with a a-v-DO2 measured directly by means of the LEXO2 (r = 0.99) or with VCO2 measured in expired gases by a capnograph (r = 0.99). In heart surgery the "on-line" monitoring of VCO2, a-v-DO2 and related parameters (REE = Resting Energy Expenditure) in the operating room and in ICU by means of a PDMS (Patients Data Management System) provides very useful information which, when integrated with haemodynamic parameters, allows a better understanding and better care of critical patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Hypermetabolic response after hypothermic cardiopulmonary bypass.

Sixteen patients undergoing hypothermic cardiopulmonary bypass for open heart surgery were studied prospectively. Oxygen consumption and CO2 production showed a marked increase during the first 6 h postoperatively. Consequently, the measured resting energy expenditure was markedly elevated compared to the predicted energy expenditure. This hypermetabolic response occurred simultaneously with maximum spontaneous rewarming after the end of surgical procedures. Ventricular function was low throughout the postoperative period, and no cardiac response to increased energy requirements was recorded. On the contrary, marked increases in arteriovenous oxygen and CO2 difference were observed during the period of highest resting energy expenditure. We conclude that the first hours after hypothermic cardiopulmonary bypass represent the period of highest risk for decompensation. The continuous monitoring of CO2 production is suggested as a useful clinical method to detect postoperative changes in metabolic rate.

Aged↗
PubMed1981

[Correlations between membrane and bubble oxygenators in patients treated with or without methylprednisolone. Haemodynamic and metabolic parameters (author's transl)].

We studied 64 patients who underwent cardiac surgery. Hemodynamic and metabolic variables-cardiac index (CI), total peripheral resistances (TSR), oxygen consumption and (VO2), urinary output, alveolar-arterial oxygen difference (delta A-a O2) - were related with oxygenator (bubble or membrane oxygenator) and with treatment (with or without methylprednisolone). 31 patients were perfused with membrane oxygenator (MO), 33 with bubble oxygenator (BO), 13 patients MO and 18 patients, BO were treated with methylprednisolone (mps). The analyzed variables were sampled 15 minutes after the start and one to five times during the perfusion. At first data were analyzed in terms of mean values in whole set of time intervals. Only delta A-a O2 showed statistically significant difference between the MO and the BO group (282 +/- 110 versus 361 +/- 82, p less than 0.005). Between nomps-treated and mps-treated patients statistically significant difference were found in TSR (2.134 +/- 362 versus 1.785 +/- 317, p less than 0.005) and in delta A-a O2 (293 +/- 92 versus 355 +/- 108, p less than 0.02). Secondo analysis is concerning time change of variables. The time behaviour of TSR is similar in all groups studied, but a statistically significant lower value was found in mps-treated patients in every time interval. The VO2, in the last time interval, is statistically higher in the mps-treated than in the nomps-treated patients (p less than 0.05) and furthermore, for the same temperature change, the rise of VO2 is higher in the mps-treated (p less than 0.001). The delta A-a O2 shows time increase both in the MO and in the BO group, but the MO patients start from statistically significant lower values than the BO and the behaviours remain parallel for all analyzed time. The results are interpreted and discussed in relation to hemodynamic and metabolic patterns of perfusion as good or bad tissue perfusion.

Cardiac Surgical Procedures↗
PubMed1980

[Anesthesia problems in thoracic and lung surgery; the use of althesin as an alternative solution].

Cardiocirculatory stability and arterial blood oxygenation represent the major problems in chest and lung surgery. The need to cut ventilation off from one of the lungs, or from a segment of a lung, may lead to dangerous haemodynamic and respiratory changes. The use of neuroleptoanalgesia guarantees marked cardiocirculatory stability but problems arise out of the need to administer high percentage nitrogen protoxide with consequent hypoxaemia. The use of Althesin surmounted this inconvenience and made it possible to keep basic haemodynamic parameters (heart stroke volume, peripheral resistances, lung resistances) and respiratory parameters (partial pressure in O2 and CO2 in the arterial and venous blood) stable.

Adult↗