1
|
Karacanoğlu D, Bedir E, Nakip ÖS, Kesici S, Duran H, Bayrakci B. Dialoxygenation: A Preclinical Trial for Transforming the Artificial Kidney Into an Oxygenator. ASAIO J 2024:00002480-990000000-00523. [PMID: 39008795 DOI: 10.1097/mat.0000000000002260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
Critically ill patients sometimes require tandem application of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) which is easier and cheaper. We aimed to transform the kidney membrane into a lung membrane by adding hydrogen peroxide (H 2 O 2 ) to the dialysate as the oxygen source. A solution containing H 2 O 2 and a dialysate fluid mixture was used as the final dialysate. Starting with 100% H 2 O 2 solution and gradually reducing the volume of H 2 O 2 , respectively: 50%, 10%, 5%, 4%, 3%, 2%, and 1%. PRISMAFLEX system, Prismaflex M60 set and a bag of packed red blood cells (pRBCs) were the prototype. blood flow rate was about 40 ml/minute and the dialysis rate was about 200 ml/m 2 /minute/1.73 m 2 . blood sampling times were; at the beginning ( T0 ), at 15th ( T1 ), 30th ( T2 ), 60th ( T3 ) minutes. Amongst eight attempts H 2 O 2 concentration that increased the partial oxygen pressure (pO 2 ) level significantly in a reasonable period, without any bubbles, was 3%. Methemoglobinemia was not observed in any trial. After the test with 3%, H 2 O 2 in the dialysate fluid decreased progressively without any H 2 O 2 detection at post-membrane blood. Three percent H 2 O 2 solution is sufficient and safe for oxygenation in CRRT systems. With this new oxy-dialysate solution, both pulmonary and renal replacement can be possible viaa single membrane in a simpler manner.
Collapse
Affiliation(s)
- Dilek Karacanoğlu
- From the Department of Pediatric Intensive Care Medicine, Center for Life Support Practice and Research, Hacettepe University, Ankara, Türkiye
| | - Esra Bedir
- Department of Materials Science and Nanotechnology Engineering, TOBB University of Economics and Technology, Ankara, Türkiye
- UNAM-National Nanotechnology Research Center and Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, Türkiye
| | - Özlem Saritaş Nakip
- Department of Pediatric Intensive Care Unit, Etlik City Hospital, Ankara, Türkiye
| | - Selman Kesici
- From the Department of Pediatric Intensive Care Medicine, Center for Life Support Practice and Research, Hacettepe University, Ankara, Türkiye
| | - Hatice Duran
- Department of Materials Science and Nanotechnology Engineering, TOBB University of Economics and Technology, Ankara, Türkiye
- UNAM-National Nanotechnology Research Center and Institute of Materials Science and Nanotechnology, Bilkent University, Ankara, Türkiye
| | - Benan Bayrakci
- From the Department of Pediatric Intensive Care Medicine, Center for Life Support Practice and Research, Hacettepe University, Ankara, Türkiye
| |
Collapse
|
2
|
Schwärzel LS, Jungmann AM, Schmoll N, Seiler F, Muellenbach RM, Schenk J, Dinh QT, Bals R, Lepper PM, Omlor AJ. A mock circulation loop to test extracorporeal CO 2 elimination setups. Intensive Care Med Exp 2020; 8:52. [PMID: 32915322 PMCID: PMC7484925 DOI: 10.1186/s40635-020-00341-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Extracorporeal carbon dioxide removal (ECCO2R) is a promising yet limited researched therapy for hypercapnic respiratory failure in acute respiratory distress syndrome and exacerbated chronic obstructive pulmonary disease. Herein, we describe a new mock circuit that enables experimental ECCO2R research without animal models. In a second step, we use this model to investigate three experimental scenarios of ECCO2R: (I) the influence of hemoglobin concentration on CO2 removal. (II) a potentially portable ECCO2R that uses air instead of oxygen, (III) a low-flow ECCO2R that achieves effective CO2 clearance by recirculation and acidification of the limited blood volume of a small dual lumen cannula (such as a dialysis catheter). Results With the presented ECCO2R mock, CO2 removal rates comparable to previous studies were obtained. The mock works with either fresh porcine blood or diluted expired human packed red blood cells. However, fresh porcine blood was preferred because of better handling and availability. In the second step of this work, hemoglobin concentration was identified as an important factor for CO2 removal. In the second scenario, an air-driven ECCO2R setup showed only a slightly lower CO2 wash-out than the same setup with pure oxygen as sweep gas. In the last scenario, the low-flow ECCO2R, the blood flow at the test membrane lung was successfully raised with a recirculation channel without the need to increase cannula flow. Low recirculation ratios resulted in increased efficiency, while high recirculation ratios caused slightly reduced CO2 removal rates. Acidification of the CO2 depleted blood in the recirculation channel caused an increase in CO2 removal rate. Conclusions We demonstrate a simple and cost effective, yet powerful, “in-vitro” ECCO2R model that can be used as an alternative to animal experiments for many research scenarios. Moreover, in our approach parameters such as hemoglobin level can be modified more easily than in animal models.
Collapse
Affiliation(s)
- Leonie S Schwärzel
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Anna M Jungmann
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Nicole Schmoll
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Frederik Seiler
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Ralf M Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Joachim Schenk
- Department of Transfusion Medicine and Hemostaseology, University Hospital of Saarland, Homburg, Germany
| | - Quoc Thai Dinh
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany.
| | - Albert J Omlor
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| |
Collapse
|
3
|
Oxygen delivery to the blood stream by the dialysis fluid during continuous renal replacement therapy ex vivo. J Artif Organs 2019; 22:104-109. [PMID: 30603819 DOI: 10.1007/s10047-018-1085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
Continuous renal replacement therapy (CRRT) maintains a balance in body water and electrolytes. CRRT supplies a higher quantity of fluid than intravenous fluid therapy along with simultaneous fluid withdrawal. We hypothesized that use of a high-oxygen-containing solution for high-volume fluid exchange would improve oxygenation in the blood during CRRT. To start with, we prepared a solution containing high oxygen. The objective of this study was to determine if this solution would increase the partial pressure of oxygen (pO2) in the blood more than that using a conventional solution during CRRT. We compared the gas profile of the experimental fluid ex vivo in a simulated CRRT for 24 h, using 2-L batches of bovine blood. A significant increase in the pO2, pH, and total oxygen delivery, and a significant decrease in the partial pressure of carbon dioxide (pCO2) were estimated in the bovine blood using the experimental solution during the simulated CRRT. This method is simpler to apply for oxygenation than the conventional method, and will be beneficial to hypoxic patients in terms of improving their blood oxygenation during CRRT.
Collapse
|