Systemic mastocytosis successfully managed using CytoSorb® during cardiopulmonary bypass for aortic valve replacement.

ABSTRACT: We describe the case of a 72-year-old male with a history of systemic mastocytosis scheduled for on-pump aortic valve replacement for severe aortic insufficiency. Anesthesia and peri-operative management included avoidance of histamine-releasing drugs, methylprednisolone and clemastin prophylaxis. Furthermore, a CytoSorb® cartridge has been added to the bypass circuit and hemoadsorption was performed throughout the entire cardiopulmonary bypass (CPB) duration. CytoSorb® is a hemoadsorption device designed to remove various cytokines and drugs from the blood. The use of CytoSorb® during CPB in our case was not associated with adverse events, and the patient did not present any allergic or anaphylactic reaction.

Hemodynamic oxygenator exchange-related effects during veno-venous extracorporeal membrane oxygenation for the treatment of acute SARS-CoV-2 respiratory distress syndrome.

Few patients with coronavirus disease 2019-associated severe acute respiratory distress syndrome (ARDS) require veno-venous extracorporeal membrane oxygenation (VV-ECMO). Prolonged VV-ECMO support necessitates repeated oxygenator replacement, increasing the risk for complications. Transient hypoxemia, induced by VV-ECMO stop needed for this procedure, may induce transient myocardial ischemia and acutely declining cardiac output in critically ill patients without residual pulmonary function. This is amplified by additional activation of the sympathetic nervous system (tachycardia, pulmonary vasoconstriction, and increased systemic vascular resistance). Immediate reinjection of the priming solution of the new circuit and induced acute iatrogenic anemia are other potentially reinforcing factors. The case of a critically ill patient presented here provides an instructive illustration of the hemodynamic relationships occurring during VV-ECMO support membrane oxygenator exchange.

[Metabolic acidosis in critical care : theoretical and practical aspects]. / L'acidose métabolique aux soins intensifs : considérations théoriques et aspects pratiques.

Acid-base disorders, and metabolic acidosis in particular, are frequently encountered in critical care typically in shock states, metabolic diseases decompensations or intoxications. Their systematic and careful evaluation frequently helps identifying underlying disease and guide clinical management. In most instances, therapy should focus on the underlying disease. Symptomatic treatment of metabolic acidosis is controversial and rarely indicated. This review focuses on the main causes of metabolic acidosis and their diagnostic approach.

Les troubles acido-basiques et l'acidose métabolique (AM) en particulier sont très fréquemment rencontrés aux soins intensifs, notamment dans les états de choc, les décompensations de maladies métaboliques ou les intoxications. L'analyse systématique et minutieuse de ces anomalies permet souvent d'orienter le diagnostic de la maladie sous-jacente et de guider la prise en charge clinique. Le traitement est généralement celui de la cause sous-jacente. Le traitement symptomatique de l'AM est, par contre, largement controversé et rarement indiqué. Cet article propose de rappeler les différentes causes d'AM et leur approche diagnostique.