The cardiopulmonary bypass circuit must be primed with fluid to allow adequate blood flow without air embolism risks. Historically, whole blood was used but increased risks. Solutions now use crystalloids like lactated Ringer's or colloids like albumin and hydroxyethyl starch. Acceptable hemodilution is 25-30% hematocrit. Additional components like calcium, steroids, and bicarbonate are sometimes added. Adequacy of perfusion under hemodilution is assessed using measures like EEG, renal function, and blood gases.
The cardiopulmonary bypass circuit must be primed with fluid to allow adequate blood flow without air embolism risks. Historically, whole blood was used but increased risks. Solutions now use crystalloids like lactated Ringer's or colloids like albumin and hydroxyethyl starch. Acceptable hemodilution is 25-30% hematocrit. Additional components like calcium, steroids, and bicarbonate are sometimes added. Adequacy of perfusion under hemodilution is assessed using measures like EEG, renal function, and blood gases.
Slide per la gestione del sondino nasogastrico ed orogastrico. Slide approntate da Stefano Bambi per lezioni universitarie nei corsi di laurea triennale in infermieristica e medicina
This document discusses the treatment of pulmonary arterial hypertension (PAH), including:
- Approved PAH therapies such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids.
- The three main pathways involved in PAH pathogenesis.
- Treatment recommendations for PAH associated with congenital heart disease, including the use of PAH-specific therapies.
- Evidence that PAH-specific therapies can reduce mortality in patients with Eisenmenger syndrome.
- Lung transplantation is an option for patients with inadequate response to maximal PAH therapy.
H trattamento dell’ipertensione arteriosa polmonareguch-piemonte
This document discusses the treatment of pulmonary arterial hypertension. Pulmonary arterial hypertension has several underlying causes, with the most common being idiopathic pulmonary arterial hypertension at around 50% of cases. Medications are the primary treatment and work to dilate blood vessels and improve heart function. These include endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, prostanoids, and soluble guanylate cyclase stimulators. In severe cases, lung transplantation may be considered.
1. I Corso GUCH
Torino, 5-6 maggio 2014
IL CUORE MONOVENTRICOLARE
G Agnoletti
Citta’ della salute, TORINO
gagnoletti@cittadella salute.to.it
2. Definizione
Varie classificazioni anatomiche e
fisiopatologiche.
La correzione biventricolare e’ preclusa
perché sono presenti una o piu’ delle
seguenti condizioni:
• Cavità ventricolare unica
• Ipoplasia di un ventricolo
• Atresia di una valvola AV
9. Circolazione di tipo Fontan
OK solo se
• La PAP e’ bassa
• Il ventricolo
funziona bene
10. Circolazione di Fontan
Il paradosso:
Uguaglianza delle pressioni polmonari e
cavali
Buon Fontan:
• Pressioni cavali abbastanza basse da
prevenire la stasi
• Pressioni polmonari abbastanza alte da
garantire il precarico del ventricolo sx
• PAPm tra 10 e 15 mmHg
11. Nel VU la portata e’ fissa
Il precarico e’ fisso
Non c’e’ modulazione da sforzo
TUTTI
i pazienti soffrono di stasi
venosa e ipoperfusione
sistemica
12. • Cardiopatia nativa: si, raro
• Cardiopatia corretta senza difetti residui:
……..
• Cardiopatia corretta con difetti residui: …….