Timing of adding blood to prime affects inflammatory response to neonatal cardiopulmonary bypass.

Complications from systemic inflammation are reported in neonates following exposure to cardiopulmonary bypass. Although the use of asanguinous primes can reduce these complications, in neonates, this can result in significant haemodilution, requiring addition of blood. This study investigates whether the addition of blood after institution of bypass alters the inflammatory response compared with a blood prime. Neonatal swine were randomised into four groups: blood prime, blood after bypass but before cooling, blood after cooling but before low flow, and blood after re-warming. All groups were placed on central bypass, cooled, underwent low flow, and then re-warmed for a total bypass time of 2 hours. Although haematocrit values between groups varied throughout bypass, all groups ended with a similar value. Although they spent time with a lower haematocrit, asanguinous prime groups did not have elevated lactate levels at the end of bypass compared with blood prime. Asanguinous primes released less tumour necrosis factor α than blood primes (p=0.023). Asanguinous primes with blood added on bypass produced less interleukin 10 and tumour necrosis factor α (p=0.006, 0.019). Animals receiving blood while cool also showed less interleukin 10 and tumour necrosis factor α production than those that received blood warm (p=0.026, 0.033). Asanguinous primes exhibited less oedema than blood primes, with the least body weight gain noted in the end cool group (p=0.011). This study suggests that using an asanguinous prime for neonates being cooled to deep hypothermia is practical, and the later addition of blood reduces inflammation.

Audiovisual Distraction Increases Prefrontal Cortical Neuronal Activity and Impairs Attentional Performance in the Rat.

Involvement of attentional processes is generally evidenced by disruption of behavior in the presence of distracting stimuli. The medial prefrontal cortex (mPFC) seems to play a role in fine-tuning activity during attentional tasks. A novel titration variant of the 5-choice serial reaction time task (5-choice serial reaction time titration variant [5CTV]) that adjusts task difficulty based on subject performance was used to evaluate the effects of audiovisual distraction (DSTR) on performance and mPFC single spike activity and local field potential (LFP). Attention was impaired in the 5CTV from DSTR, and mPFC spike activity was increased, whereas LFP was reduced. The increased spike activity in the mPFC in conjunction with DSTR suggests that conflicting attentional demands may contribute to the reduced task performance. As both hypo- and hyperactivation of the mPFC may contribute to attentional disruption, further studies using the 5CTV are needed to understand mPFC activity changes in real time during disruption of performance by other types of behavioral or neurobiological manipulations.

Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study.

BACKGROUND: Venovenous extracorporeal life support (VV ECLS) has been reported in adult trauma patients with severe respiratory failure; however, ECLS is not available in many trauma centers, few trauma surgeons have experience initiating ECLS and managing ECLS patients, and there is currently little evidence supporting its use in severely injured patients. This study seeks to determine if VV ECLS improves survival in such patients. METHODS: Data from two American College of Surgeons-verified Level 1 trauma centers, which maintain detailed records of patients with acute hypoxemic respiratory failure (AHRF), were evaluated retrospectively. The study population included trauma patients between 16 years and 55 years of age treated for AHRF between January 2001 and December 2009. These patients were divided into two cohorts as follows: patients who received VV ECLS after an incomplete or no response to other rescue therapies (ECLS) versus patients who were managed with mechanical ventilation (CONV). The primary outcome was survival to discharge, and secondary outcomes were intensive care unit and hospital length of stay (LOS), total ventilator days, and rate of complications requiring intervention. RESULTS: Twenty-six ECLS patients and 76 CONV patients were compared. Adjusted survival was greater in the ECLS group (adjusted odds ratio, 0.193; 95% confidence interval, 0.042-0.884; p = 0.034). Ventilator days, intensive care unit LOS, and hospital LOS did not differ between the groups. ECLS patients received more blood transfusions and had more bleeding complications, while the CONV patients had more pulmonary complications. A cohort of 17 ECLS and 17 CONV patients matched for age and lung injury severity also demonstrated a significantly greater survival in the ECLS group (adjusted odds ratio, 0.038; 95% confidence interval, 0.004-0.407; p = 0.007). CONCLUSION: VV ECLS is independently associated with survival in adult trauma patients with AHRF. ECLS should be considered in trauma patients with AHRF when conventional therapies prove ineffective; if ECLS is not readily available, transfer to an ECLS center should be pursued. LEVEL OF EVIDENCE: Therapeutic study, level III.

Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy.

BACKGROUND: This study evaluates the efficacy of negative-pressure therapy (NPT) in preventing surgical site infections (SSIs) in high-risk surgical oncology patients. METHODS: A retrospective analysis of 191 operations for colorectal, pancreatic, or peritoneal surface malignancies was performed. Incisional NPT was used in patients with multiple SSI risk factors. Rates of SSIs were compared with patients treated with a standard sterile dressing (SSD). RESULTS: NPT was used in 104 patients, whereas SSDs were used in 87 patients. Despite being at an increased risk of SSI, patients treated with NPT developed fewer superficial incisional SSIs compared with SSD patients (6.7% vs 19.5%, P = .015). In a subgroup analysis of clean-contaminated cases, NPT was associated with fewer superficial incisional SSIs (6.0% vs 27.4%, P = .001), fewer total SSIs (16.0% vs 35.5%, P = .011), and fewer wound openings for any reason (16.0% vs 35.5%, P = .011). CONCLUSIONS: Our findings suggest that NPT decreases SSIs in high-risk surgical oncology patients.