Academic literature on the topic 'Cardiac surgery in the conditions of artificial circulation'

IntroductionThe study of the clinical and phenomenological features of psychopathological complications of cardiac surgery (CS) in artificial circulation conditions (ACC), the development of modern approaches to early diagnosis and prognosis of psychopathology is an effective way to solve this problem has valid medical and social significance.ObjectivesTo increase the effectiveness of prevention of psychopathological disorders in cardiosurgical interventions based on personalization of their correction.MethodsThe examination included the use of socio-demographic, instrumental, biochemical, clinical-psychopathological, psychometric, and statistical methods.ResultsThe study sample consisted of 700 patients who were treated by CS in ACC at the SI “Heart Institute of the MH of Ukraine”.It was found out that the most common complication is postsurgeon cognitive dysfunction (PCD) (72.0% of patients), postsurgeon encephalopathy (PE) (31.0%) is less common, and cerebral infarction (CI) is the least common (12.2%).It was revealed that the core psychopathological symptoms associated with CS are cognitive disorders (72.0% of the examined) and affective symptoms, represented by depressive (38.1%) and anxiety (33.9%) manifestations of mild and moderate expressiveness, and auxiliary constructs – dyssomnic (29.7%), asthenic (17.9%) and somatovegetative (9.0%) disorders. The highest prevalence of psychopathological symptoms was found in patients with CI, somewhat less in patients with PE, and the lowest in patients with PCD.Signs of mild depressive disorder were found in patients who underwent CS in ACC, elevated levels of adynamic depression indicators, depression with fear and agitated depression, as well as increased levels of anxiety: the average level of anxiety, mental and somatic anxiety. The indicators of expressiveness of depression and anxiety in patients with CI turned out to be the highest, in patients with PE – lower, and in patients with PCD – the lowest.We proposed a mathematical model for predicting the development of psychosocial maladjustment (PM) in patients who have undergone CS in ACC. It is based on a comprehensive assessment of three key vectors that can have a mutually potentiating pathogenetically related effect on the course of the formation of PM: surgical, neurological, and psychopathological. A complex of diagnostic, corrective and preventive measures for each of the risk groups has been developed.ConclusionsVerification of the proposed model on a representative sample of patients confirmed its high predictive ability and reliability in use.Disclosure of InterestNone Declared

The study was conducted in the period from January 2018 to December 2018 inclusive, 452 coronary artery bypass grafts were performed in the cardiac surgery department using artificial blood circulation under conditions of cold pharmacoplegia. During the study, 2 groups of patients were identified. The criteria were the timing of the surgical intervention. The first group consisted of patients who underwent elective surgery (n = 59). The second group consisted of patients undergoing emergency surgery.

On a limited contingent of patients who died and survived after cardiac surgery under conditions of artificial circulation, a general nonspecific adaptive reaction is considered – stress, which develops during the sequential implementation of the “anxiety stage”, “resistance” and “resolution”. The immune markers of the stress response, its ambiguous changes in deceased patients and those discharged from the clinic with improved health are considered. Interesting innovations in changes in patients have been discovered that can be used in assessing the condition of patients, predicting the outcome of cardiac surgery, and even substantiating the use of immunomodulatory therapy in alternative clinical and immunological changes in the state of health in patients.

Acute kidney injury (AKI) associated with cardiac surgery in children is one of the most frequent complications of the postoperative period appearing due to various perioperative factors. Generally accepted criteria for the diagnosis of AKI, on the one hand, may underestimate the frequency of development of this complication, on the other hand, require verification for use in the pediatric population. The application of kidney injury markers in pediatric practice is associated with a number of difficulties. For example, the high variability of the concentration of markers depending on age complicates the interpretation of the result, and maternal molecules can circulate in the blood of newborns. At the same time, in the cardiac surgery practice, the greatest impact of the measurement of kidney injury markers in children has been noted, which allows significantly accelerate the diagnosis of this complication and the starting of its therapy.

BACKGROUND: Regional anesthesia reduces pain impulse transmission, which reduces hormonal and metabolic responses to operational stress. No studies have reported on the use of combined anesthesia, such as endotracheal anesthesia and femoral nerve block, in cardiac surgery.
 OBJECTIVE: To determine the efficacy of combined anesthesia by analyzing the cortisol, glucose, and lactate levels in cardiac surgery.
 MATERIALS AND METODS: Prospective cross-sectional study was conducted. The study included 60 cardiac surgery patients. The patients were divided into two groups: group 1, with endotracheal anesthesia and femoral nerve blockade, and group 2, with endotracheal anesthesia (control group). All patients underwent aortocoronary bypass grafting under artificial circulation conditions. Cortisol, glucose, and lactate levels at the five stages of the perioperative period were investigated.
 RESULTS: Data analysis showed that the cortisol level of patients with combined anesthesia was significantly 1.2 times lower (p=0.042) than that in the control group in step 2. Glucose levels were significantly lower in the combined anesthesia group by 1.28 times (p=0.0017) than in the control group in step 4 and significantly lower by 1.2 times (p=0.0016) in step 5. Additionally, lactate level was significantly lower in the combined anesthesia group than in the control group in step 4 by a factor of 1.3 (p=0.03) and in step 5 by a factor of 1.35 times (p=0.005).
 CONCLUSION: The determination of cortisol, glucose, and lactate levels can be used as a component of endocrine-metabolic anesthesiological monitoring when performing cardiac surgery under artificial circulation conditions. Stable parameters of endocrine-metabolic monitoring were established using both anesthesia methods. The use of femoral nerve block in combined anesthesia reduces stress response to surgery.

Aim To study the contribution of preoperative anemia to the prognosis of adverse clinical events (mortality, complications, transfusion) in patients with ischemic heart disease (IHD) after myocardial revascularization in the conditions of artificial circulation.Material and methods This retrospective cohort study included 1 133 patients with IHD who had undergone isolated myocardial revascularization in the conditions of artificial circulation in 2019. The primary endpoints were mortality and a composite endpoint that included, in addition to mortality, cases of acute coronary syndrome, heart, respiratory and renal failure, neurological deficit, and infectious complications. The secondary endpoints were duration of artificial ventilation of more than 12 h, duration of stay in the resuscitation and intensive care unit (RICU) of more than one day, and duration of postoperative inpatient treatment of more than 7 days. Results Preoperative anemia was found in 196 (17.3 %) patients. The anemia was not associated with mortality but increased the risk of the composite endpoint, prolonged artificial ventilation, stay in RICU for more than one day, and red blood cell transfusion. Despite the absence of a relationship between red blood cell transfusion and mortality, the use of transfusion was associated with increased risks of the composite endpoint and prolonged stay in the RICU and hospital.Conclusion Preoperative anemia is a risk factor for adverse outcomes of myocardial revascularization in the conditions of artificial circulation. Timely treatment of preoperative anemia may improve outcomes of the treatment.

Introduction: Patient sedation in the intensive care unit after cardiac surgeries with cardiac pulmonary bypass (CPB) has an element of negative impact on the hemodynamic status of the patient. Vasoplegia caused by the use of of artificial blood circulation in combination with the use of hypnotics can lead to a large number of complications and increase the duration of the patient’s stay in the conditions of the intensive care unit. Purpose: to compare the effect on the hemodynamic status of patients after cardiac surgery with the use of artificial blood circulation 3 drugs for sedation: propofol, dexmedetomidine and their combination. Materials and methods: A randomized controlled parallel study was conducted. The study included 356 patients over 18 years of age who underwent cardiac surgical treatment with CBP. Statistical data processing was carried out on the basis of Prism 9.0 software. Results and discussion: The frequency of hemodynamic disturbances that required vasopressors in the early postoperative period was 35.79% (n= 34) in the propofol group (n= 95) ,12.35% (n = 10) in the group of the combination of propofol and dexmedetomidine (n= 81), 31.25% (n=5) dexmedetomidine sedation group (n= 16). (p=0.0011) Conclusions: Vasopressors infusion has been less common in the propofol and dexmedetomidine combination group (p = 0.0011).

Currently, special attention of researchers is attracted to the problem of diagnosing postoperative brain damage and cognitive impairment in patients with cardiovascular pathology after cardiac surgery without/under conditions of artificial circulation (AC). The main method of assessing the functional state of the brain is quantitative electroencephalography (EEG). Because of cardiovascular and oncological pathology could persist in one patient it is actual simultaneous cardial and oncological surgery under EEG monitoring.Objective: based on the literature data, to find out the role of EEG in diagnosis of cerebral complications in patients with cardiovascular pathology after cardiac surgery without /under conditions of AC.Methods. We found and analyzed data in specialized medical data base Pubmed, Scopus, Web of Science about EEG methods in patients after heart bypass with/without AC from 1980 to 2023 years.Results. The quantitative EEG is very important for early diagnosis and prognosis for cerebral ischemia, epileptiform activity, postoperative cognitive dysfunction in patients with coronary heart disease (CHD) after coronary artery bypass with/without AC. However, the studies did not included patients with oncopathology, people over 70 years of age. It opens possibilities for early diagnosis of central nervous system functional condition in patients with lung cancer and cardiovascular disorders in simultaneous (concomitant heart and lung with/without AC) surgery. It will help a correction of complications in time and a development of guided rehabilitation

The goal the work was to study the possibility of using elastography on an open heart to determine the stiffness of the left ventricular myocardium. Material and methods. Intraoperative elastography was performed in 6 patients with isolated aortic stenosis and dissecting aneurysm of the ascending aorta with aortic insufficiency. Three patients underwent surgery to replace the aortic valve with mechanical prostheses (SIM-19) and three were operated to replace the ascending aorta with an artificial prosthesis with aortic valve replacement (David’s operation). The average age of the patients was 42±9 years (42–53) years. All patients underwent surgery under conditions of artificial blood circulation. Initially, elastography was evaluated on a working heart, and then on full artificial circulation. The study was performed on a VK 5000 ultrasound device with an intraoperative «stick» type sensor at a frequency of 7.5–15 Mhz, gain of 1.6 Db, resolution of 127 hz. The deformation coefficient was evaluated. The imaging program was exposed as for neurosurgery with a frequency of 15 Mhz. Visualization was performed in B-mode, followed by obtaining shear wave elastography with calculation of the deformation coefficient. Results. Wave elastography was evaluated for various heart pathologies with different myocardial thickness. It was found that the stiffness in the studied areas of the myocardium is different. Thus, in patients with atherosclerotic aortic stenosis and a pressure gradient of more than 100 mmHg, the deformation coefficient was increased, in accordance with the thickness of the myocardium and amounted to 3.81–4.06, and in patients with aortic root dilation and aortic insufficiency, the deformation coefficient was 1.64–2.9. Conclusion. Intraoperative assessment of the left ventricular myocardial deformation coefficient is possible only on a stopped heart and gives an idea of the state of the heart muscle with the possibility of soft and hard areas. Shear wave elastography provides information about the elasticity and hardness of the tissue, which indirectly reflects the viscosity of the myocardium. This study was aimed at verifying the methodology for assessing the characteristics of the elasticity of the left ventricular myocardium for myocardial overload by pressure (aortic stenosis) and volume in case of a dissecting aortic aneurysm with aortic insufficiency.

The objective: to analyze the impact of various surgical management on the duration of the ischemic period and the quality of myocardial protection during simultaneous combined correction of two-three heart valves and myocardial revascularization. Materials and methods. The results of the treatment of single-stage multivalve correction in combination with coronary artery bypass grafting in 93 patients, which was performed at the M.M. Amosov National Institute of Cardiovascular Surgery for the period from 2014 to 2021, were studied. Depending on the methods and the sequence of surgical manipulations, the patients were divided into three groups. I group – 42 patients who had the correction of heart valves firstly and then aortocoronary shunting in conditions of pharmaco-cold cardiac arrest, II group – 36 patients who first had aortocoronary bypass surgery, then valve correction in conditions of pharmaco-cold cardiac arrest, III group – 15 patients, who at the first stage had coronary artery bypass grafting on a working heart, then – correction of valve damage in conditions of pharmaco-cold cardiac arrest. Results. The use of the technique of primary restoration of coronary blood flow by shunting coronary arteries in a working heart before clamping the aorta (before pharmaco-cold cardiac arrest and the start of artificial blood circulation) allows to reduce the duration of artificial blood flow and ischemic time, which positively affects the heart rhythm in the postoperative period. Conclusions. The technique of performing aortocoronary shunting on a working heart is more effective than when performing aortocoronary shunting in conditions of pharmaco-cold cardiac arrest. This technique requires more time to perform and is technically more difficult, but it can statistically significantly reduce the time of myocardial ischemia, which reduces the frequency of severe heart failure and the frequency of postoperative complications.

Submitted in fulfillment for the degree of Master of Technology, Clinical Technology: Cardiovascular Perfusion, Durban University of Technology, Durban, South Africa, 2016.<br>Introduction: A large volume of residual haemodilute blood remains in the cardiopulmonary bypass (CPB) circuit after termination of the bypass. It is common practice in many centres to process residual pump blood with an autologus cell salvage system (ACSS), thereby producing a re-suspended red blood cell (RBC) concentrate and attenuating the need for donor blood RBC concentrate. It has also become standard practice to wash donor pack red blood cells (PRBC) before adding it to neonate cardiopulmonary circuits (Swindell et al., 2007). Manufactures of ACSS recommend 0.9% sodium chloride (NaCl) as a wash solution for processing salvaged blood. Previous studies have demonstrated that washing PRBC with normal saline results in acid-base (Huber et al., 2013) and electrolyte derangements (Varghese et al., 2007). Infusion of normal saline in healthy volunteers also results in significant changes in osmolality (Williams et al., 1999). The use of normal saline as a wash solution in processing residual CPB blood requires investigation. Aims and Objectives: This was a prospective, quantitative in vitro investigation to analyze and compare the quality of residual pump blood post CPB that had been washed with either an unbalanced electrolyte solution (0.9% normal saline) or a balanced electrolyte solution (Balsol®). Both are crystalloid solutions. The primary objective of the present study was to measure and compare the pH, electrolytes, metabolites, osmolality and strong ion difference (SID) of residual pump blood to the pH, electrolytes, metabolites, osmolality and SID of processed cell saver blood, which was washed with either 0.9% normal saline or Balsol® solution. The secondary objective was to measure and compare protein levels (albumin and total protein) in residual pump blood to protein levels in processed cell saver blood, that is washed with either 0.9% normal saline or Balsol® solution. The final objective was to determine the volume, haematocrit and haemoglobin yield post cell saver processing, from the input volume of residual pump blood when washed with either 0.9% normal saline or Balsol® solution. This was the first study of this nature done in the South African population group. Methodology: In this investigation in a series of forty patients (n=40) undergoing elective cardiac surgery with CPB, the first twenty patients were allocated to the NaCl control group (n=20) and the second twenty patients were allocated to the Balsol® interventional group (n=20). The extracorporeal circuit consisted of a standard integral hollow fibre membrane oxygenator and tubing that was primed with 1500-1800 millilitres of balanced crystalloid solution (Balsol®), for both the control group and the interventional group, and addition of 5000 iu heparin. The balanced crystalloid solution (Balsol®) is the approved standard CPB priming solution for all cardiac procedures at Inkosi Albert Luthuli Central Hospital. This setup was used with the Stockert S5 roller pump heart lung machine. The operations were performed as per protocol with standard non-pulsatile CPB and hypothermia was maintained at 28 – 32 ºC (core) and haemodilution (haematocrit 20 % to 30 %). A standard flow rate of 2.4 L/min/m² was used. Cardio protection consisted of either cold Blood Cardioplegia using the Buckberg 4:1 ratio, being four parts blood to one part cardioplegia (with the 35ml of 20 % Dextrose + 1 gram Magnesium Sulphate added per 500ml), or 20ml/kg cold St Thomas II cardioplegia (with addition of 10ml of 8.5% NaHCO3 + 100mg lignocain per litre). Topical cooling was achieved with ice cold 0.9 % saline. Maintenance fluid used during CPB was Balsol® for both the control and the interventional groups. Calcium, potassium and sodium bicarbonate was administered as required during CPB to correct deficits for both groups. Weaning of CPB was performed after re-warming to a rectal temperature of at least 35 ºC for both study groups. Immediately on termination of CPB a blood sample was taken from the sampling manifold of the CPB circuit for pre wash analysis. Residual pump blood was then flushed out with one litre of Balsol® solution for both groups and collected into the Medtronic autolog cell saver reservoir to be processed. In the control study group 0.9% NaCl was used as the wash solution and in the interventional study group Balsol® solution was used as the wash solution. After processing of the salvaged blood is complete, a blood sample was taken for post wash analysis. Clinical data recorded for pre and post wash samples included: pH, pCO2, pO2, [K+], [Na+], [Cl-], [Ca2+], lactate, glucose, [HCO3-], TCO2, haematocrit, haemoglobin (GEM 4000® premier™ blood gas analyser) blood volume (Medtronic autolog) and SID (calculated as per equation). Inorganic phosphate, total magnesium, albumin, total protein (Siemens Advia 1800 blood gas analyser) and osmolality (Gonotech osmometer) were also measured. Results: There was a highly significant decrease (p < 0.05) within the NaCl group after washing with pCO2 (28.3 ± 2.9 vs. <6.0 ± 0.0), [K+] (4.5 ± 0.5 vs. 1.0 ± 0.7), total magnesium (1.7 ± 0.7 vs. 0.29 ± 0), ionized calcium (1.0 ± 0.09 vs. 0.1 ± 0.03), inorganic phosphate (0.9 ± 0.4 vs. 0.09 ± 0.04) and SID (27.1 ± 2.1 vs. 18.4 ± 2.2). There was a highly significant increase (p < 0.05) within the NaCl group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [Na+] (132.9 ± 3.2 vs. 146.3 ± 1.9), [Cl-] (107.8 ± 3.1 vs. 127.4 ± 2.1) and osmolaltity (256.9 ± 38.4 vs. 296.2 ± 57.5). There were highly significant decrease (p < 0.05) within the Balsol® group after washing with pCO2 (30.15 ± 6.0 vs. 18.9 ± 4.9), [Na+] (134.7 ± 2.2 vs. 125.6 ± 1), [Cl-] (108.8 ± 2.7 vs. 100.2 ± 1.4), ionized calcium (0.9 ± 0.1 vs. 0.02 ± 0.04), inorganic phosphate (0.8 ± 0.2 vs. 0.1 ± 0.024) and osmolality (288.8 ± 20.6 vs. 272.8 ± 19.9). There were highly significant increase (p < 0.05) within the Balsol® group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [K+] (4.2 ± 0.4 vs 4.6 ± 0.3). Total magnesium and SID were similar after washing within the Balsol® group. Albumin and total protein revealed similar significant decreases within both groups after washing. There was a highly significant difference (p < 0.05) in the change between groups after washing in all the variables measured, except for pH, inorganic phosphate, lactate, glucose, albumin, total protein, haematocrit, haemoglobin, and blood volume. Total carbon dioxide and [HCO3-] were not compared because they were incalculable by blood gas analyser in the NaCl group. Conclusion: This investigation concluded that the balanced electrolyte solution Balsol® used for washing residual CPB blood results in a re-suspended RBC concentrate, with an osmolality and electrolyte profile that is superior compared to washing residual CPB blood with 0.9% NaCl solution.<br>M

Anaesthesia for children is tempered by changes that occur during both growth and development. Drug dose is affected by size and clearance maturation processes as well as the changing body composition that occurs with age. All organ systems undergo these maturation changes and most are complete within the first few years of life. Normal physiological variables in infancy and childhood are quite different from adults. The central nervous, cardiovascular, and respiratory systems are particularly important. Cerebral immaturity and plasticity impacts sensitivity to drugs, pain responses, and behaviour and increases potential harm from apoptosis with anaesthesia. The heart undergoes a transition from fetal to adult circulation during the first few weeks of life. Undiagnosed congenital defects are not uncommon. The neonate is very susceptible to conditions that trigger an increase in pulmonary vascular resistance, with reversion to fetal circulatory patterns. Respiratory anatomy and mechanics affect the propensity to apnoea, airway maintenance, artificial ventilation modalities, uptake of inhalational agents, and tracheal tube sizes. Metabolic rate and oxygen requirements increase with decreasing age. This physiology influences diverse aspects that include the rate of desaturation during apnoea, hypoglycaemia during starvation, cardiac output, drug metabolism, fluid requirements, and heat production or loss.

Neonatal anaesthesia requires an understanding of how neonates differ from adults and older children in anatomy, physiology, and pharmacology. There are also pathological and surgical conditions in neonates that are associated with unique anaesthesia challenges. Organ systems are generally immature, reducing the clearance of many drugs, while different water and fat content results in altered volumes of distribution. Pharmacological management is further complicated by a lack of basic pharmacokinetic data for the use of most anaesthetic drugs in neonates. At birth, there is a transition from a fetal circulation. Some aspects of fetal physiology can persist and have an impact on anaesthesia care, for example, exaggerated hypoxic pulmonary vasoconstriction. Small size, organ immaturity, and reduced physiological reserve can also result in rapid changes to cardiovascular or respiratory status during surgery. Neonates are also very vulnerable to injury, particularly pulmonary or neurological damage. Even brief episodes of over-inflation or hyperoxia may have long-lasting effects on the lung. Safe neonatal anaesthesia thus requires appropriate equipment and ventilators, careful monitoring, and the rapid management of changes in circulatory or respiratory status. Neonates that need surgery often have other significant co-morbidities; for example, prematurity, sepsis, congenital cardiac disease, or a wide variety of syndromes. Safe anaesthesia requires a careful preoperative assessment looking for such co-morbidities and a good understanding of how these may have an impact on anaesthesia.

Cardiac tamponade is an emergency, and definitive therapy is fluid removal by pericardiocentesis. In certain conditions, fluid removal is still the optimal choice, but a conservative approach using haemodialysis may be employed. Factors that influence the management strategy include evaluating the cause, providing haemodynamic support, and choosing the technique. Fluid resuscitation to maintain venous pressure and circulation may be beneficial up to a point, after which, tamponade may be aggravated. While inotropes have theoretical benefit, studies involving humans are few. Fluid removal strategies are broadly grouped into percutaneous and surgical methods. In most cases, the percutaneous approach is favoured. However, surgery is typically the first choice in blunt trauma or in proximal aortic dissection. While the safety of percutaneous methods is well established, imaging guidance is needed to avoid common complications associated with a blind technique. The proper management strategy should also minimize effusion recurrence, common methods to do so include placement of a drainage catheter, infusion of a sclerosing agent, and a balloon pericardiotomy procedure. Surgical methods for removal of pericardial fluid include the creation pericardial window, insertion of a pericardioperitoneal shunt, and pericardiectomy. The creation of a pericardial window and pericardioperitoneal shunt are safe, but pericardiectomy is associated with increased morbidity. After fluid removal has been completed, the patient should be placed in a unit that is both familiar with the signs of tamponade and has the capacity to quickly treat a significant effusion if it recurs.

Cerebrospinal fluid (CSF) within the spinal canal is far from a stagnant column of liquid, simply bathing the spinal cord, but is constantly being subjected to waves of energy, produced by both the cardiac and the respiratory cycles. Moreover, the spinal subarachnoid channels are normally in free communication with the intracranial basal cisterns and volume exchanges take place between these two compartments, during normal daily activities. A variety of pathological processes can alter CSF hydrodynamics, leading to the development of several conditions. These include Chiari malformations and syringomyelia, as well as extra-axial collections of CSF. They are best regarded as disorders of CSF circulation, rather than as isolated spinal pathologies.

Over the past decade, advancements in prenatal ultrasound and availability of fetal MRI have allowed for early diagnosis of congenital anomalies, and anesthetic and surgical developments have facilitated successful management and interventions of fetal anomalies. Fetal anomalies such as twin to twin transfusion syndrome, neural tube defects, and malformations impacting the fetal airway, cardiac, thoracic, abdominal, and urological systems affect the smallest and most vulnerable patient population. Minimally invasive, open, and ex-utero intrapartum procedures are three types of interventions available for the treatment of correctable fetal anomalies. These fetal procedures halt further progression of congenital anomalies early in fetal development and decrease fetal/neonatal morbidity and mortality.¹ Open fetal surgical procedures are indicated for neural tube defect and congenial diaphragmatic hernia repair. These open surgical procedures improve fetal conditions, and impact postdelivery disability and fetal/neonatal death.² Conditions in which the fetus’ airway may be compromised by a head or neck mass increase the newborn’s risk for respiratory and cardiovascular failure. In such situations, an ex utero intrapartum therapy (EXIT) procedure may be performed. During the EXIT procedure, the fetus remains dependent on placental oxygenation provided by the maternal circulation. Anesthetic choice for fetal surgery depends on maternal comorbidity, airway evaluation, type of fetal surgery, and surgical needs.

Abstract The solubility of gases increases in blood with decreasing temperature and consequently a decrease in partial pressures. In certain clinical conditions, a patient’s body temperature is lower than normal (e.g., ventilated patients in critical care units and floors, after cardiac arrest when return of spontaneous circulation has been achieved, and during surgery, particularly on bypass in cardiac surgical procedures). The management of acid-base balance in the hypothermic state is a topic of discussion as with decreasing temperature, PaO2 and PaCO2 also decrease, causing a lower PaCO2 and a rise in pH and an alkalotic picture at that temperature if nothing is added to the blood. When the blood gases are sent to the laboratory, the sample is warmed to 37°C and measurements performed are then corrected to the patient’s actual current body temperature. The two major schools of thought are alpha-stat and pH-stat management of blood gases in hypothermic patients. In alpha-stat, if at 37°C blood gases are in normal range, then nothing is required with an assumption that a decrease in pH on both sides of the cell membrane is in the same direction that keeps electrical neutrality in normal functioning range without causing disruption of cell function. In pH-stat, the aim is to keep blood gas values in normal range at the patient’s actual temperature by adding CO2 to raise PaCO2 and decrease pH to a normal level. Both methods have benefits and drawbacks, and no one method is considered superior to the other.

Basic results are considered of aerohydrodynamic and thermophysical experiments, in which secondary tornado-like jets (TLJ) are revealed and investigated. These jets are self-organized under conditions of flow past surfaces with three-dimensional recesses (dimples) with a second-order curvilinear surface (TLJS – tornado-like jet surface). Exact solutions are given of unsteady-state Navier–Stokes and continuity equations, which describe the TLJ. The impact is considered, which is made on the flow in dimple by forces forming a flow of new type with built-in secondary tornado-like jets. These forces are absent in the case of flow past initially smooth surfaces. The problems are discussed of reducing the aerohydrodynamic drag on the TLJS, of enhancing the heat and mass transfer with the level of hydraulic loss lagging behind the degree of enhancement, of increasing the critical heat loads under conditions of boiling and supercritical flows of continuous medium past the TLJS, of preventing cavitation damage to the TLJS in hydraulic apparatuses, of reducing the adsorption of foreign matter on these surfaces, of reducing the friction between TLJS rubbing against one another, and of raising the efficiency of facilities for tornadolike conversion of energy of renewable low-potential sources. It is demonstrated that the obtained exact solutions of Navier–Stokes and continuity equations provide an adequate model of generation and evolution of swirling flow of blood in human blood circulation system, which enables one to proceed to development of safe and effective devices for substitution of organs in cardiac surgery. An inference is made about the universality of the flow of new type for raising the efficiency of technologies involving flows of various media.