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J P Dearing

Publications and source records attributed to J P Dearing.

7 recordsLinked to original sources
PubMed1985

A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass.

The ideal priming fluid for cardiopulmonary bypass is not known. We designed a study to determine whether there are important differences in the clinical effects of hydroxyethyl starch versus albumin when used in priming fluid, and in the clinical effects of colloid versus crystalloid priming fluid. We prospectively randomized 83 adult patients undergoing coronary artery bypass or valve replacement. All patients were managed by standardized protocol, and they received one of three priming fluids for bypass: hydroxyethyl starch (HES), 26 patients; albumin (ALB), 28 patients, and lactated Ringer's solution (LRS), 29 patients. The groups were stratified by body weight and type of operation. We measured 41 variables relating to operative time factors, fluid balance, bleeding, and organ function (renal, cardiac, and pulmonary) at several time intervals. The LRS group had a significantly lower colloid osmotic pressure than the other two groups, and the HES group had a substantially higher blood viscosity. Although the prothrombin time was significantly lower in the LRS group (p less than 0.05), the differences were very small and not clinically important. The platelet count in the HES group was significantly lower than in the other two groups immediately after bypass, but it was not different by the time the patients left the operating room. There were no differences among the groups in chest tube drainage, blood bank usage, or fluid balance. Postoperatively, the pulmonary shunt fraction was significantly greater in the LRS group. Body weight increased more in the LRS than in the HES and ALB groups (p = 0.01). No adverse reaction to the prime solutions was noted. The differences between the HES and ALB groups--prothrombin time, platelet count, and blood viscosity--had no apparent clinical effects; thus, the two may be considered clinically equivalent. The greater somatic and pulmonary fluid accumulation in the LRS group suggests that colloid is preferable to crystalloid in priming fluid.

Albumins↗
PubMed1982

Hydroxyethyl starch in priming fluid for cardiopulmonary bypass.

The physiochemical characteristics of hydroxyethyl starch make it suitable for use as a colloidal blood plasma substitute. In high doses, this drug may interfere with blood coagulation. Because of its effectiveness and low cost, we have used hydroxyethyl starch rather than albumin in the priming fluid for cardiopulmonary bypass: 500 ml of 6% hydroxyethyl starch and 2,000 ml of lactated Ringer's solution. To determine if excessive bleeding has been associated with the use of hydroxyethyl starch, we reviewed 760 cardiac operations. The patients were 49.9 +/- 0.5 years old (mean +/- SEM) and weighed 73 +/- 1 kg. Blood loss during the first postoperative day was 578 +/- 25 ml, and 4.0 +/- 0.2 units of bank blood were utilized in the perioperative period. We have used an improved method of administering heparin and protamine for the past 3 years. In the 461 patients operated upon since then, blood loss was 437 +/- 21 ml, 2.9 +/- 0.1 units of bank blood were used, and excessive postoperative bleeding necessitated re-exploration in nine patients (2.0%). These results compare favorably with other recently published series in which hydroxyethyl starch was not used in the pump prime. Thus the dose of hydroxyethyl starch in our priming fluid does not appear to be associated with excessive bleeding. In view of its safety and low cost, hydroxyethyl starch is a suitable colloidal blood plasma substitute for use during cardiopulmonary bypass.

Cardiopulmonary Bypass↗
PubMed1981

Augmentation of pulmonary blood flow after right ventricular bypass.

We have studied pulmonary hemodynamics after right ventricular bypass in dogs. Manipulations of pulmonary vascular resistance and transpulmonary blood pressure difference (delta Pp) made it possible to increase pulmonary blood flow. Decreasing resistance by raising arterial pH from 7.25 to 7.38 increased flow by 24.9%. Infusion of homologous blood to increase right atrial pressure from 10 to 30 mm Hg lowered resistance 41.5% and raised flow 183%. Left ventricular bypass (left atrium to aorta) lowered left atrial pressure, increased arteriovenous pressure gradient by 41.4%, and raised flow 32.8%. These experiments support earlier clinical observations of the importance of low pulmonary vascular resistance and of good left ventricular function both in selection of patients and in postoperative management after right ventricular bypass. Attention to the principles we discuss may permit right ventricular bypass operation in some patients who would not be operable by current criteria.

Animals↗
PubMed1980

A prospective randomized study of membrane versus bubble oxygenators in children.

We studied 60 children, 2 weeks to 10 years old, prospectively by randomly assigning them to a SciMed membrane oxygenator or Harvey bubble oxygenator. Variables of cardiopulmonary bypass (CPB) were closely controlled: prime, circuit configuration, flow rate, and blood gases. Blood variables measured at eight intervals before, during, and after operation were as follows: seven plasma proteins, free hemoglobin, formed elements, and clotting functions. Preoperatively and postoperatively, we evaluated brain function (psychological testing), renal function (creatinine clearance), and pulmonary function (compliance changes and postoperative shunt function). Postoperative blood loss, fever, and length of hospitalization were also evaluated. We compared 302 variables by computer program. No difference (p greater than 0.05) between the two groups was found in any variable related to CPB or organ function (pulmonary, renal, or cerebral) or in hematological variables except free hemoglobin. After 5 and 60 minutes of CPB and the next day, it was significantly lower (p less than 0.05) in the group with a membrane oxygenator. Safety, cost, and convenience, not physiology, should be the major factors in considering membrane versus bubble oxygenators for cardiac operations in children.

Blood Cell Count↗
PubMed1979

Calculation of systemic blood flow with pulmonary artery thermistor probe.

A simple thermodilution technique is described for determining systemic blood flow with right atrial and left atrial catheters and a pulmonary arterial thermistor probe. Injections of cold water into the atrial catheters provide computer display readings that permit direct calculation of systemic blood flow. The method is convenient for determining systemic blood flow in postoperative patients with a residual left-to-right shunt.

Blood Circulation↗