Perfusion.com

Message Topic Search Topic Options Post Reply Create New Topic Printable Version

   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?

Author	Message Topic Search Topic Options Post Reply Create New Topic Printable Version
madwilli Members Profile Send Private Message Find Members Posts Add to Buddy List Pumpling Joined: Nov 28 2006 Online Status: Offline Posts: 2	Quote Reply Topic: Neurological problems in ICR 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?

flando Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: Nov 29 2006 at 11:26am
	Whats in your prime?

Mary Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: Nov 30 2006 at 11:04am
	What is ICR? How warm do you get?

Larry Frounfelkner Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: Dec 01 2006 at 9:33am
	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

tanny klasna Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: Dec 01 2006 at 1:53pm
	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

willi Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: Dec 04 2006 at 5:06am
	ICR - Intra Cardiac repair

willi Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: Dec 04 2006 at 5:25am
	Ringer Lactate NahCo3 Mannitol

FlowisKing Members Profile Send Private Message Find Members Posts Add to Buddy List Pumpling Joined: Apr 27 2007 Location: United States Online Status: Offline Posts: 4	Quote Reply Posted: Apr 27 2007 at 12:54pm
	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.

Guests Members Profile Send Private Message Find Members Posts Add to Buddy List Guest	Quote Reply Posted: May 08 2007 at 8:17am
	whats hemodynamic changes during this period

Asmar Members Profile Send Private Message Find Members Posts Add to Buddy List Pumpling Joined: May 09 2007 Location: Saudi Arabia Online Status: Offline Posts: 10	Quote Reply Posted: May 09 2007 at 7:16am
	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.

Neurological problems in ICR