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Peds > 4. Plegia and MUF- Exam 1 > Flashcards

4. Plegia and MUF- Exam 1 Flashcards

1
Q

When choosing a cpg system- what 4 things do we look for in peds

A

Small prime
Good heat exchange
Air handling capabilities
**A versatile system

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2
Q

What 5 things are included in a cpg circuit

A 
Blood shunt
Crystalloid component
Blood component
Heat exchanger/Bubble trap
Air detector
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3
Q

what component of the cpg is very important

A

priming dial

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4
Q

why does the CSC-14 use a 4-way stop cock w/ purge line

A

use one as a recirc line and the second as a pressure pop off line and the third as a pressure monitor.

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5
Q

Retrograde cpg (coronary sinus)- DLP cannula size for neonate

A

6 F

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6
Q

Retrograde cpg (coronary sinus)- DLP cannula size for pediatrics

A

10 F

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7
Q

Retrograde cpg (coronary sinus)- DLP cannula size for small adults

A

13F

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8
Q

Retrograde cpg (coronary sinus)- DLP cannula size for adults

A

15F

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9
Q

What cpg had the greates marketing ploy ever

A

sorin CSC 14

most people think the 14 represents only 14ml of prime but thats not the case

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10
Q

hard tip coronary ostium cpg cannula sizes

A

10, 12, 14 F

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11
Q

soft tip coronary ostium cpg cannula sizes

A

universal

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12
Q

aortic root cpg cannula size for: 0-7 kg

A

18 guage

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13
Q

aortic root cpg cannula size for: 7-20 kg

A

16 guage

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14
Q

aortic root cpg cannula size for: 20-35 kg

A

14 guage

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15
Q

aortic root cpg cannula size for: >35kg

A

12 guage

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16
Q

LV vent cannula size and type for: <14 kg

A

DLP Malleable tip= surgeons request

DLP Curved LV Vent= 10F

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17
Q

LV vent cannula size and type for: 14-30 kg

A

DLP Curved LV Vent= 13F

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18
Q

LV vent cannula size and type for: 30-50 kg

A

DLP Adult LV Vent= 16F

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19
Q

LV vent cannula size and type for: >50 kg

A

DLP Adult LV Vent= 20F

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20
Q

antegrade delivery dose and target root pressure for peds

A

30 ml/kg
70 mmHg
*Make sure to look at pre-op pressures

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21
Q

why is there no exact dose for peds

A

flow is variable depending on patient size- so the dose and time of dose is weight based

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22
Q

where is retrograde delivered into

A

coronary sinus

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23
Q

after retrograde is delivered into the coronary sinus- A
balloon is inflated or self inflated and provides what two
functions:

A

Prevents backflow

Holds cannula in place

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24
Q

with retrograde cpg- flow is variable based on size. Flow should be titrated to maintain a coronary sinus
pressure of what?

A

30-40 mmHg

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25
Q

what coronary sinus pressure should not be exceeded in peds

A

40 mmHg

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26
Q

Are there other avenues CP might be
given in pediatrics?
(What other vessel – think congenital anomalies)

A

Arch- PDA
go off bypass
bump CPG up
screw it into the aortic or PDA cannula

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27
Q

with DHCA- you have to go off bypass before doing what

A

delivering cpg- remember to recirc

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28
Q

Myocardial-protection strategies are used to halt the ________ of the heart and to allow intracardiac procedures to be performed in a motionless, bloodless field

A

mechanical contractions

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29
Q

how much blood is in custodial cpg

A

none

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30
Q

The myocardial-protection strategy is designed to sufficiently ____________, so that myocardial function can resume at the end of the procedure with minimal dysfunction

A

reduce myocardial oxygen consumption

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31
Q

action potential phase 0=

A

Na+ influx (sodium arrest)

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32
Q

action potential phase 1=

A

Transient K+ efflux

33
Q

action potential phase 2=

A

Ca++ efflux

34
Q

action potential phase 3=

A

K+ efflux (potassium arrest

35
Q

action potential phase 4=

A

Na/K ATPase

36
Q

Blood cardioplegia solution is typically a mixture of what

A

4 parts of oxygenated blood and 1 part crystalloid solution

37
Q

The addition of blood to the cardioplegic solution enhances what

A

oxygen delivery, especially at the microcirculation level.

38
Q

8:1 has more or less blood

A

more

39
Q

1:8 has more or less blood

A

less

40
Q

% of blood based cpg

A

86%

41
Q

% of crystalloid based cpg

A

14%

42
Q 
BLOOD-BASED CPG SOLUTION KIDLETS
Del Nido solution (1:4) \_\_%
Customized solutions \_\_%
St. Thomas, Plegisol, or Baxter \_\_%
Microplegia \_\_%
A

Del Nido solution (1:4) 38%
Customized solutions 32%
St. Thomas, Plegisol, or Baxter 11%
Microplegia 5%

43
Q

CRYSTALLOID CPG KIDLETS
Custodiol __%
St. Thomas, Plegisol, or Baxter __%
customized solutions __%

A

Custodiol 7%
St. Thomas, Plegisol, or Baxter 5%
customized solutions 2%

44
Q

Cold ( __%

Antegrade administration __%

A

Cold ( 21%

Antegrade administration 89%

45
Q

____________ cardiopulmonary bypass is more common in neonates and infants

A

Moderate (28° to 31°C) hypothermic

46
Q

Longer intervals between cardioplegia doses were associated with surgeons using _____ and _____.
(these solutions were commonly administered with a single dose _______ of aortic cross-clamp time)

A

del Nido and Custodiol solutions

regardless

47
Q

Myocardial protection techniques still remained highly _____ among congenital heart surgeons

A

variable

48
Q

This survey demonstrates that there is a _______ that del Nido and Custodiol solutions can offer appropriate myocardial protection for longer intervals with decreased repeat dosing.

A

perception

49
Q

4: 1 ((blood:crystalloid) is ____
1: 4 (blood:crystalloid) is ____

A

normal

Del Nido

50
Q

what form of cpg is a “pinkish solution”

A

del nido

51
Q

Lies between depolarizing and hyperpolarizing solutions. It has a Osmolarity of ___ mOsm/L

A

340 mOsm/L

52
Q

Del Nido dosing

A

20 mL/kg arrest

10 mL/kg maintenance

53
Q

what rate (ml/min) do you deliver del nido at

A

90-180 mL min

54
Q

describe custodial solution

A

Intracellular solution
Low Na arrest
Single administration: up to 2 hours

55
Q

what is in a custodial solution

A

Histidine
Tryptophan
Ketoglutarate

56
Q

Histidine=

A

buffer- against acidosis during XC

57
Q

Tryptophan=

A

stabilizes cell membrane

58
Q

Ketoglutarate=

A

improves ATP production during reperfusion

59
Q

The addition of magnesium may provide a protective effect on the _________________

A

hypoxic-ischemic immature heart

60
Q

hypoxic-ischemic immature heart. This effect probably due to what 3 things

A

the antiarrhythmic effect of magnesium
inhibited entry of calcium into the myocytes
decreased uptake of sodium by myocytes during ischemia

61
Q

Magnesium is exchanged for ____ during reperfusion

A

calcium

62
Q

what is the purpose of MUF

A

To allow recovery of the pump blood for the patient, while allowing the patient to be in a hemodynamic state to accept the volume is the a significant advance for pediatric perfusionists

63
Q

who was MUF developed by and in what year

A

Developed Mr. Martin Elliott (Great Ormand Street/Hospital for Sick Children London UK) in 1985

64
Q

name the 7 effects of MUF

A

A. Raising Hct
B. Extravascular fluid crosses (increase in COP & OSMO)
C. Removes inflammatory mediators
D. C-Reactive Proteins cross
E. Protein reactive cytokines cross
F. Complement activation factors cross (C3a, sC56-9, C3 bound)
G. Pulmonary effects > Systemic effects with IL-6, IL-8, and TNF

65
Q

MUF after CPB in infants did result in ________ in both static and dynamic pulmonary compliance, but the effect was not sustained after __________ after the operation

A

immediate improvements

admission to the PICU or 24 hours

66
Q

Name 3 reasons why MUF IMPROVEMENTS are NOT SUSTAINED

A
  1. pulmonary compliance is affected both by excess fluid from the hemodilutional effect of bypass (As well as by the systemic inflammatory response)
  2. Ultrafiltration after CPB decreases total body water and removes inflammatory cytokines. However, the initiation of the systemic inflammatory response most likely occurs during rewarming. (MUF starts after the inflammatory cascade has been activated)
  3. the effects of hemoconcentration and removal of water after CPB by MUF are unable to overcome the ongoing effects of capillary leak possibly caused by an activated ongoing inflammatory response
67
Q

The technique of MUF is performed after CPB is complete and allows filtration of both the …

A

patient and remaining contents of the CPB circuit, including the venous reservoir

68
Q

Using the MUF technique, an ultrafilter is interposed in the CPB circuit between the ____ and ____. After weaning from CPB, the blood is removed from the patient via the _____ and fed through the ultrafilter. The outlet of the ultrafilter is fed to the _____ of the patient

A

aortic arterial line and the venous
aortic canula
right atrium

69
Q

Blood flow through the ultrafilter approximates

A

20mL/kg/min max

70
Q

Suction is applied to the filter port of the ultrafilter, resulting in an ultrafiltration rate of ____ mL per minute. A constant left atrial or right atrial pressure is maintained, achieving continued _________ in the patient

A

100 to 150 ml/min

hemodynamic stability

71
Q

Ultrafiltration is carried out with the end point being either time (_____ minutes) or the achievement of a hematocrit value of approximately ______

A

10–20

40-50%

72
Q

name 5 benifits of MUF

A
  1. total body water is reduced as a direct result of removing the ultrafiltrate.
  2. Reduced edema
  3. Reduced hospital stay
  4. Reduced ventilation times
  5. Reduced incidence of pleural and pericardial effusions.
73
Q

name 5 arguments against MUF

A
  1. Possible air embolism
  2. Remember that air would be entering venous side
  3. Circuit complexity and cost
  4. Prolonged exposure to foreign surface
  5. “Patient can be concentrated before coming of CPB”
74
Q

Endpoints of hemofiltration vary among institutions and can be defined by (3)

A

time, volume, or hematocrit

75
Q

In the postoperative period, patients receiving MUF have smaller increases in _____

A

total-body weight

76
Q

In addition to decreasing edema, hemofiltration increases the hematocrit, which translates into _____

A

increased oxygen-carrying capacity

77
Q

Removed fluids also contain _____ and _____

A

inflammatory mediators and vasoactive substances

78
Q

CLINICAL STUDIES HAVE DEMONSTRATED THAT MUF IS ASSOCIATED WITH what 4 things

A
  1. Increased ventricular systolic function;
  2. Improved cerebral blood flow (CBF), cerebral metabolic activity, cerebral oxygen delivery
  3. Pulmonary function: decreased postoperative ventilation
  4. Decreased postoperative bleeding, chest-tube drainage, pleural effusions

Peds (17 decks)

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