Friday, April 20, 2018
Neurological problems in ICR |
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madwilli ![]() Pumpling ![]() ![]() Joined: Nov 28 2006 Online Status: Offline Posts: 2 |
![]() ![]() ![]() Posted: Nov 28 2006 at 7:31am |
We are facing a difficult problem with ICR babies, till extubation(after 24 hrs) after ICR correction - there is no sign of neurological problems etc., but soon after that within 10 hrs they are developing Cerebral hemorrhage. We used Haemofilter, SNP during rewarming and Mean arterial pressure was maintained about 35-45 for <15 kg patients. We cooled down to 28C. Haematocrit was maintained around 27. Can somebody explain this? Is there any problem in perfusion technique or anaesthetic problem?
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flando ![]() Guest ![]() |
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Whats in your prime?
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Mary ![]() Guest ![]() |
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What is ICR?
How warm do you get?
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Larry Frounfelkner ![]() Guest ![]() |
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I agree with Randy that you should consider hypernatremia. NaHCO3 increases serum osmolarity and sodium levels and can result in brain damage and intracranial bleeding from changes in the cerebral spinal fluid.
Giving 3 mEq./kg. of NaHCO3 results in an increase of 7.5 mOsm./kg in serum osmolarity. Hope this helps.
Larry Frounfelkner, CCP
CPMC, San Francisco
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tanny klasna ![]() Guest ![]() |
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Please forgive my ignorance, but what does ICR stand for. I am an adult perfusionist and former neonatal nurse, but have never heard that abbreviation.
I'm sorry for your situation, maybe if I understand it better I can help.
Thank you.
Tanny Klasna, RN, BSN, CCP
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willi ![]() Guest ![]() |
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ICR - Intra Cardiac repair
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willi ![]() Guest ![]() |
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Ringer Lactate
NahCo3
Mannitol
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FlowisKing ![]() Pumpling ![]() ![]() Joined: Apr 27 2007 Location: United States Online Status: Offline Posts: 4 |
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Consider your plasma oncotic pressure. If it is too low capillary leak and possible brain bleeds. Consider 25% albumin. Decrease priming volume drastically. Consider using THAM instead of NaHCO3.
What kind of flows are you running? Too high of flow could be culprit
Directions of arterial cannula jet could be cause...
Do you MUF? Do use ultrafiltrate / ZBUF/DUF during procedure? Consider using all of these techniques. Stive to remove or run a lot of volume through the patient and out of your ultrafiltrator. Aggressively MUF to acheive very high hemaglobins.
What blood products are administered post CPB and in ICU? Look at these and increase or decrease use.
Steroids in patient or in pump? Consider solumedrol.
These are just suggestions. The more info you provide on your circuit and techniques them more support you will recieve.
Hope these help.
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Guests ![]() Guest ![]() |
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whats hemodynamic changes during this period |
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Asmar ![]() Pumpling ![]() ![]() Joined: May 09 2007 Location: Saudi Arabia Online Status: Offline Posts: 10 |
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consider arterial cannula site , R U doing circulatory arrest with antegrade cerebral perfusion !!! how about the mannitol dose! and what kind of crystalloid R U priming with?.all of the above can be a contributing factors.
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