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Russ M, Ott S, Bedarf JR, Kirschfink M, Hiebl B, Unger JK. Increased compensatory kidney workload results in cellular damage in a short time porcine model of mixed acidemia - Is acidemia a 'first hit' in acute kidney injury? PLoS One 2019; 14:e0218308. [PMID: 31206554 PMCID: PMC6576776 DOI: 10.1371/journal.pone.0218308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/30/2019] [Indexed: 12/20/2022] Open
Abstract
Acute kidney injury (AKI) corrupts the outcome of about 50% of all critically ill patients. We investigated the possible contribution of the pathology acidemia on the development of AKI. Pigs were exposed to acidemia, acidemia plus hypoxemia or a normal acid-base balance in an experimental setup, which included mechanical ventilation and renal replacement therapy to facilitate biotrauma caused by extracorporeal therapies. Interestingly, extensive histomorphological changes like a tubular loss of cell barriers occurred in the kidneys after just 5 hours exposure to acidemia. The additional exposure to hypoxemia aggravated these findings. These ‘early’ microscopic pathologies opposed intra vitam data of kidney function. They did not mirror cellular or systemic patterns of proinflammatory molecules (like TNF-α or IL 18) nor were they detectable by new, sensitive markers of AKI like Neutrophil gelatinase-associated lipocalin. Instead, the data suggest that the increased renal proton excretion during acidemia could be an ‘early’ first hit in the multifactorial pathogenesis of AKI.
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Affiliation(s)
- Martin Russ
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Sascha Ott
- Department of Experimental Medicine, Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Janis R. Bedarf
- Department of Neurology, University of Bonn, Bonn, Germany
- German Centre for Neurodegenerative Disease Research (DZNE), Bonn, Germany
| | - Michael Kirschfink
- Institute for Clinical Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Bernhard Hiebl
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour and Virtual Center for Replacement–Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Juliane K. Unger
- Department of Experimental Medicine, Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Gao W, Liu Y, Jing G, Li K, Zhao Y, Sha B, Wang Q, Wu D. Rapid and efficient crossing blood-brain barrier: Hydrophobic drug delivery system based on propionylated amylose helix nanoclusters. Biomaterials 2017; 113:133-144. [DOI: 10.1016/j.biomaterials.2016.10.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/18/2016] [Accepted: 10/27/2016] [Indexed: 12/13/2022]
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Moeller C, Fleischmann C, Thomas-Rueddel D, Vlasakov V, Rochwerg B, Theurer P, Gattinoni L, Reinhart K, Hartog CS. How safe is gelatin? A systematic review and meta-analysis of gelatin-containing plasma expanders vs crystalloids and albumin. J Crit Care 2016; 35:75-83. [DOI: 10.1016/j.jcrc.2016.04.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 12/22/2022]
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Goonasekera CD, Wang J, Bunchman TE, Deep A. Factors affecting circuit life during continuous renal replacement therapy in children with liver failure. Ther Apher Dial 2014; 19:16-22. [PMID: 25195689 DOI: 10.1111/1744-9987.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 11/29/2022]
Abstract
Despite abnormal clotting, circuits clot during continuous renal replacement therapy (CRRT) in children with acute liver failure (ALF). We report our experience. All children with ALF needing CRRT were studied over 2 years. Patient and circuit factors associated with circuit use were evaluated. Thirty-one children in liver failure (median age 7.4 years) underwent CRRT, of which 17 (54.8%) died. A total of 98 filtration episodes were used. The smallest access catheter was 6.5 Fr, while the largest was 13.5 Fr. The most common filter used was HFO7 (63%). Mean duration (SD) of circuit use was 33.13(30.83) hours. Of the 98 filtration episodes, circuits blocked in 25, whereas the access catheter blocked in 25. Fifty-two circuits were changed electively for a variety of reasons. Prostacyclin was the anticoagulant in 62 filtration episodes. The remaining filtration episodes had either no anticoagulation or heparin. The mean (SD) "downtime" was 5.13 (9.15) hours. We found a significant association between fresh frozen plasma (FFP) use with circuit blockade. Neither the duration of CRRT nor the "downtime" influenced mortality. The CRRT circuits blocked in children despite deranged clotting in liver disease. Circuits are changed for a variety of reasons other than clotting. The use of FFP reduces circuit life.
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Bedarf JR, Grosch-Ott S, Russ M, Wagner JJ, Hiebl B, Kirschfink M, Unger JK. Impact of different types of resuscitation fluids on coagulation and continuous venovenous hemofiltration hemocompatibility in a porcine model. Ther Apher Dial 2013; 17:510-23. [PMID: 24107280 DOI: 10.1111/1744-9987.12014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Intensive therapy demanding diseases (organ failure or sepsis) are assumed to be the etiology behind a decreased biocompatibility of extracorporeal systems for renal replacement therapy (RRT). There are also potential interactions between different components of the overall therapy. Volume substitutes are known to influence hemorheology and coagulation. To define a potential net effect of volume substitutes on the hemocompatibility of an RRT, we chose an animal model without interfering pathophysiologies. According to the problem of early filter failure and coagulation disorders in critically ill patients, we focused on the hypothesized interaction between RRT and different volume substitutes with respect to blood cell counts, coagulation parameters and required heparin dose. Forty-eight pigs were assigned to four groups of fluid therapy with either normal saline (NaCl), 6%HES130kD/0.4 (HES130), 6%HES200kD/0.5 (HES200) or 4%gelatin (GEL). Six pigs of each fluid group underwent continuous venovenous hemofiltration (CVVH), the remaining six served as the control group. Anticoagulation was performed with continuous heparin infusion. CVVH was run in a recirculation-mode for 4.5 h to force hemocompatibility reactions, thereafter in a standard-mode for 2 h. During the CVVH-treatment GEL reduced platelet counts and fibrinogen concentration and additionally lowered ATIII levels. Heparin requirements did not differ between different volume substitutes or CVVH and control groups. Severe pathophysiologies are not the only reason for a reduced hemocompatibility of CVVH treatment. Interaction of a particular volume substitute with CVVH should be considered when interpreting study results and evolving new strategies.
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Affiliation(s)
- Janis Rebecca Bedarf
- Department of Experimental Medicine (FEM), Charité-Universitätsmedizin Berlin, Berlin, Germany
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Wagner JJ, Bedarf JR, Russ M, Grosch-Ott S, Keckel T, Hiebl B, Schell H, Unger JK. Adverse influence of mixed acidemia on the biocompatibility of continuous veno-venous hemofiltration with respect to the lungs. Artif Organs 2013; 37:1049-58. [PMID: 23738674 DOI: 10.1111/aor.12104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Experimental data indicate that hypercapnic adidosis has anti-inflammatory effects. These anti-inflammatory effects may even be a beneficial property in case of low tidal volume ventilation with consecutive hypercapnic acidosis. It is unclear whether these anti-inflammatory effects predominate in critically ill patients who suffer from multiple pro- and anti-inflammatory insults like extracorporeal organ support (pro-inflammatory), metabolic acidosis (pro- and anti-inflammatory), as well as hypoxia (pro-inflammatory). Eighteen pigs were randomized into three groups, mechanically ventilated and connected to a continuous veno-venous hemofiltration (CVVH) as pro-inflammatory insult. A reference group with normal acid-base state obtained normoventilation; a normoxemic acidemia group obtained normoxemic, mixed acidemia due to infusion of lactic and hyperchloremic acid and low tidal volume ventilation, and in a hypoxemic acidemia group the mixed acidemia was paralleled by hypoxemia. Lung histology including pulmonary leukocyte invasion, blood gases, blood cell counts, and hemodynamics were examined. The histological examination of the lungs of acidemic pigs showed a suppressed invasion of leukocytes and thinner alveolar walls compared with normoventilated and with hypoxemic pigs. Enhanced congestion and alveolar red blood cells (RBCs) combined with an increase of the pulmonary artery pressure were observed in acidemic pigs in comparison with the reference group. Normoxemic acidemia reduced the pro-inflammatory reaction to the CVVH and mechanical ventilation in the ventilated lung areas in the form of pulmonary leukocyte invasion. However, this did not result in reduced scores for lung injury. Instead, an increased score for criteria which represent lung injury (congestion and alveolar RBCs) was observed in acidemic pigs.
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Russ M, Bedarf JR, Grosch-Ott S, Haltern C, Rossaint R, Unger JK. First level prevention instead of third level intervention-review of research to improve biocompatibility and performance of capillary membrane apheresis in critically ill patients. Artif Organs 2013; 37:501-12. [PMID: 23578278 DOI: 10.1111/aor.12020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In intensive care medicine, convection-based apheresis is of growing interest. Applying extracorporeal systems in the critically ill patient can cause severe complications like nosocomial infections and bleeding, which can be worsened or even initialized by the anticoagulation protocol used. Furthermore, the filter modules (hemo- and plasmafilters) often tend to a fast blockage. A decrease in sieving performance due to membrane fouling may be tolerable for some time, but the complete blockage of high percentages of hollow fibers, which is named "clotting," often requires the immediate exchange of the filter. Extracorporeal detoxification and high clearance renal replacement regimes both require high blood flow and filtration rates. As a consequence, filter clotting and anticoagulation-associated bleeding are the most sensitive aspects in these applications. We were interested in the paradox phenomenon of the parallel occurrence of intra vitam bleeding and filter clotting in critically ill patients. Through stepwise investigations based on in vitro and animal experiments, we identified a stasis of blood flow followed by blood cell sedimentation and aggregation ("clogging") as the main factor of hollow fiber blockage in hemo- and plasma filters. As a result, various aspects which increase the risk of stasis inside the hollow fibers were investigated, for example, patient's hemorheology, configuration of an extracorporeal treatment system including interaction of catheter features with the filtration procedure, and basic therapeutic approaches such as colloidal volume substitutes and tolerated acidosis. Finally, an etiological triad for the blockage of hollow fibers due to filter clogging and consecutive filter failure was formed.
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Affiliation(s)
- Martin Russ
- Departments of Anesthesiology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany.
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In a porcine model of mixed acidemia HES 130/0.4 may support more stable hemodynamics during CVVH when compared to gelatine. Int J Artif Organs 2012; 35:180-90. [PMID: 22461113 DOI: 10.5301/ijao.5000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE Continuous veno-venous hemofiltration (CVVH) and mixed acidemia often occur simultaneously in critically ill patients. In a previous study in non-acidemic pigs we found that colloids and CVVH interact specifically with respect to hemodynamic stability, with favorable effects for 6% HES 130/0.4 versus 4% gelatine (GEL) infusion. In a porcine model, we investigated whether these colloid-type associated differences are still dominant under acidemic conditions. METHODS We utilized 5 groups, a non-acidemic reference group receiving HES130 and CVVH; two acidemic groups receiving HES130 infusion (one with and one without CVVH); and two acidemic groups receiving GEL infusion (one with and one without CVVH). Mixed acidemia (pH ~7.20) was established by low tidal volume ventilation and acid infusion. Stable acidemia/CVVH application was maintained for 3 hours. Hemodynamics and blood gases were recorded. RESULTS Mixed acidemia led to a significant decrease in MAP and increase in MPAP in all groups. CVVH led to a further decrease in MAP but improved MPAP. During CVVH, HES130 ensured significantly higher MAP, Hb, and DO2 values than GEL infusion. In the groups without CVVH these differences between HES 130/0.4 and GEL were not observed. CONCLUSIONS As in a previous study in non-acidemic pigs, we found a colloid-specific influence of HES130 versus GEL on hemodynamics during CVVH under acidemia. Again, HES130 infusion may lead to favorable effects. In contrast, acidemia without CVVH application was dominant over the impact of a respective colloid. The application of a CVVH seems to be an important trigger for the overall circulatory response to a particular colloid.
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Lou S, Bian L, Long C, Wang Z, Ma J, Zhou B. Does 6% hydroxyethyl starch 130/0.4 impact differently on blood glucose than 4% gelatin in patients receiving open heart surgery? Perfusion 2011; 27:113-8. [PMID: 22002968 DOI: 10.1177/0267659111426920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To investigate whether starch-based colloid may impact differently on blood glucose than a gelatin-based colloid in adult patients receiving open heart surgery. Methods: 70 adult patients scheduled for elective first-time cardiac surgery were enrolled and randomized into two groups. The circuits were primed with either 6% HES 130/0.4 or 4% gelatin. The peak glucose level, incidence of hyperglycemia, glucose variation and glucose level at different time points during operation were compared between the two groups. A p-value ≤ 0.05 was accepted as significant. Results: The peak glucose (150±30mg/dl vs 142±27, p=0.236) and glucose variation demonstrated by standard deviation (26±12mg/dl vs 23±11mg/dl, p=0.202) were comparable between the two groups. Repeated measurement ANOVA revealed that the main effect for artificial colloid was not significant (p=0.349). Conclusions: With the data available, we could not prove that starch-based colloid (HES130) had a different impact on intra-operative blood glucose than a gelatin-based colloid in adult patients receiving open heart surgery.
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Affiliation(s)
- S Lou
- Department of Cardiopulmonary Bypass, FuWai Hospital, Beijing, China
| | - L Bian
- Department of Cardiopulmonary Bypass, FuWai Hospital, Beijing, China
| | - C Long
- Department of Cardiopulmonary Bypass, FuWai Hospital, Beijing, China
| | - Z Wang
- Department of Cardiopulmonary Bypass, FuWai Hospital, Beijing, China
| | - J Ma
- Department of Cardiopulmonary Bypass, FuWai Hospital, Beijing, China
| | - B Zhou
- Department of Cardiopulmonary Bypass, FuWai Hospital, Beijing, China
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Russ M, Deja M, Ott S, Bedarf J, Keckel T, Hiebl B, Wagner JJ, Unger JK. Experimental High-Volume Hemofiltration With Predilutional Tris-Hydroxymethylaminomethane for Correction of Low Tidal Volume Ventilation-Induced Acidosis. Artif Organs 2011; 35:E108-18. [DOI: 10.1111/j.1525-1594.2011.01204.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Russ M, Esche V, Ott S, Bedarf J, Unger JK. Stable mixed acidemia in anesthetized pigs--a model for research on biocompatibility of hemofilters under a deteriorated acid-base balance. Artif Organs 2011; 35:192-6. [PMID: 21323687 DOI: 10.1111/j.1525-1594.2010.01053.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In recent years, acidosis has been of growing interest in intensive care medicine. Most animal models only provide a short-term investigation of the effects of acidosis. They are not suitable for research on interactions with extracorporeal organ support (here continuous venovenous hemofiltration, CVVH). The rationale for this study was to establish a porcine model of prolonged mixed acidemia, which is suitable for research on the interactions of acidemia and CVVH. After the induction of anesthesia in pigs (40 kg), acidemia was induced and maintained in one group with a bolus of 0.4 mol/L lactic acid followed by continuous infusion and a reduced respiratory frequency (lactic acid-group, n = 4). In another group, mixed acidemia was induced with a 0.4 mol/L acid solution (lactic and hydrochloric acid) and low tidal volume ventilation (mixed acidemia-group, n = 8). To get first proof of the model's suitability to operate over an extracorporeal circuit, CVVH was additionally performed in seven pigs (mixed acidemia/CVVH-group, n = 7). The target for the pH was 7.19-7.24. The targeted pH was constantly missed in the lactic acid group, whereas it was successfully maintained for 3.5 h in four out of eight pigs of the mixed acidemia group, and in five out of seven pigs of the mixed acidemia/CVVH group. The CVVH was performed successfully for 3 h in all pigs of the respective group. The mixed acidemia model was sufficient to maintain a low pH within a narrow range for some hours and enabled research on hemofilters in vivo.
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Affiliation(s)
- Martin Russ
- Department of Experimental Medicine (FEM), Charité--Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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Russ M, Ott S, Bedarf JR, Haacke N, Keckel T, Unger JK. Prolonged hypoxemia and acidemia in anesthetized pigs: a model for research on extracorporeal organ support in an intensive care setting. Int J Artif Organs 2011; 33:544-52. [PMID: 20872349 DOI: 10.1177/039139881003300805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE Hypoxemia and acidemia (hypoxemia/acidemia) are serious complications in the critically ill and often occur in unstable patients exposed to extracorporeal organ support. Still, little is known about the biocompatibility interactions of hypoxemia/acidemia with extracorporeal circuits (ECC). Existing animal models often include the release of mediator cascades (sepsis-, lung injury models) or are based on small laboratory animals. We established a porcine model of hypoxemia/acidemia without an underlying disease and further challenged the situation with an extracorporeal circuit (ECC). METHODS Hypoxemia/acidemia were induced (3.5 h) and maintained (3 h) in anesthetized pigs (40 kg) by a stepwise reduction in oxygenation, infusion of 0.4 mol.l⁻¹ lactic and hydrochloric acid and by low tidal volume ventilation, targeting an PaO₂ < 70 mmHg, SvO₂ < 65%, pH ~ 7.2. Venovenous hemofiltration (CVVH) operated in recirculation mode without volume exchange was chosen to prove the suitability of the model for studies on ECCs under clinical conditions (ECC group, n=6). Another 6 animals underwent the same protocol except for the CVVH (reference group, n=6). RESULTS The median PaO₂ during hypoxemia/acidemia was 62 mmHg, the median SvO₂ was 38%, and the median pH was 7.22. Hypoxemia/acidemia was successfully induced and maintained for 6.5 h in all pigs. CVVH could be performed for 3 h with blood flow rates up to 300 ml.min⁻¹ and filtrate rates up to 60 ml.min⁻¹. CONCLUSIONS Our model provides hypoxemia/acidemia with blood gas values comparable to critically ill adult patients for several hours, during which it is possible to perform CVVH. Thus, it enables research on the biocompatibility reactions of extracorporeal circuits under intensive care conditions.
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Affiliation(s)
- Martin Russ
- Department of Experimental Medicine (FEM), Charité - Campus Virchow, Humboldt University, Berlin, Germany
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Bedarf JR, Russ M, Ott S, Keckel T, Kirschfink M, Unger JK. Influence of acidaemia and hypoxaemia on CVVH haemocompatibility in a porcine model. Nephrol Dial Transplant 2010; 25:2960-9. [DOI: 10.1093/ndt/gfq126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Six percent hydroxyethyl starch 130/0.4 impacts differently on blood glucose than 4% gelatine in a swine model of mixed acidaemia. Eur J Anaesthesiol 2009; 26:1026-31. [DOI: 10.1097/eja.0b013e3283304d31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang P, Li Y, Li J. Hydroxyethyl starch 130/0.4 prevents the early pulmonary inflammatory response and oxidative stress after hemorrhagic shock and resuscitation in rats. Int Immunopharmacol 2009; 9:347-53. [DOI: 10.1016/j.intimp.2008.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 12/20/2008] [Accepted: 12/22/2008] [Indexed: 11/16/2022]
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Buffer capacity of 4% succinylated gelatin does not provide any advantages over acidic 6% hydroxyethyl starch 130/0.4 for acid-base balance during experimental mixed acidaemia in a porcine model. Eur J Anaesthesiol 2008; 25:905-16. [PMID: 18652713 DOI: 10.1017/s0265021508004869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Four percent gelatine is an alkaline compound due to NH2 groups, whereas 6% hydroxyethyl starch 130/0.4 (HES130) has acidic features. We investigated whether these solutions lead to differences in acid-base balance in pigs during acidaemia and correction of pH. METHODS Anaesthetized pigs were randomized to HES130 or gelatine infusion (n = 5 per group). Animals received acid infusion (0.4 M solution of lactic acid and HCl diluted in normal saline) and low tidal volume ventilation (6-7 mL kg(-1), PaCO2 of 80-85 mmHg, pH 7.19-7.24). Measurements were made before and after induction of acidaemia, before and after correction of pH with haemofiltration (continuous venovenous haemofiltration) and tris-hydroxymethylaminomethane infusion. We measured parameters describing acid-base balance according to Stewart's approach, ketone body formation, oxygen delivery, haemodynamics, diuresis and urinary pH. RESULTS Acid-base balance did not differ significantly between the groups. In HES130-treated pigs, the haemodilution-based drop of haemoglobin (1.4 +/- 1.0 g dL(-1), median +/- SD) was paralleled by an increase in the cardiac output (0.5 +/- 0.4 L min(-1). Lacking increases in cardiac output, gelatine-treated pigs demonstrated a reduction in oxygen delivery (149.4 +/- 106.0 mL min(-1)). Tris-hydroxymethylaminomethane volumes required for pH titration to desired values were significantly higher in the gelatine group (0.7 +/- 0.1 mL kg(-1) h(-1) vs. HES130: 0.5 +/- 0.2 mL kg(-1) h(-1)). CONCLUSION The buffer capacity of gelatine did not lead to favourable differences in acid-base balance in comparison to HES130.
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WHAT'S NEW IN SHOCK, MAY 2006. Shock 2006. [DOI: 10.1097/01.shk.0000215323.29736.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Unger JK, Haltern C, Portz B, Dohmen B, Gressner A, Rossaint R. Relation of haemofilter type to venous catheter resistance is crucial for filtration performance and haemocompatibility in CVVH--an in vitro study. Nephrol Dial Transplant 2006; 21:2191-201. [PMID: 16567341 DOI: 10.1093/ndt/gfl068] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Main factors for the overall performance of haemofilters (HF) are membrane features and filter durability without clogging/clotting of capillaries. However, the venous line resistance (Pv) is a powerful force for net filtrate flux resulting in haemoconcentration and thus is enhancing the phenomenon of membrane clogging. Therefore, we hypothesized that catheter type, as it is associated with Pv-levels, contributes to the extent in which filter longevity and filtration performance are restricted due to blocked hollow fibres. METHODS Heparinized porcine blood (5 IU/ml) was circulated in an in vitro system for haemofiltration (FH6S-filters were used, Ca. Gambro). Three different sizes of catheters for peripheral vein access (Vygonuele V, Ca. Vygon) were alternately inserted into the circuit for blood return from the filter to the reservoir. To produce Pv-levels lower than commonly induced by Shaldon catheters, a 14G-vygonuele was used. Pv-levels standard for 11-12 French catheters were provided by using a 16G-vygonuele. To produce Pv-levels common for low-French or tri-lumen catheters, a shortened 18G-vygonuele was used. The respective Pv-levels attained were compared with respect to the overall filtration performance (system pressures, haemocompatibility and sieving coefficients). RESULTS Catheters of 14 and 16G enabled transiently maximal blood flow (Qb)/filtration rates (Qf) of 300/60 ml/min and continuous filtration with Qb/Qf of 200/40 ml/min. The shortened 18G catheter reduced maximal flow rates down to Qb/Qf of 200/40 ml/min, and continuous flow rates down to Qb/Qf of 125/25 ml/min. At the end, median values for blocked hollow fibres were, 35% in the 14G-group, 40% in the 18G-group and 70% in the 16G-group. Haemocompatibility appeared to be higher in the 14G-group with respect to various parameters when compared with the other groups. CONCLUSIONS The flow resistance by the catheter chosen for haemofiltration clearly influenced the filtration performance. Thus, investigations focused on compatibility of catheter type as it related to Pv-levels with the particular method of renal replacement therapy that should be performed. This point could be crucial in reducing filter clogging and haemostasis during CVVH.
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Affiliation(s)
- Juliane K Unger
- Department of Comparative Medicine and Experimental Animal Sciences, Charité Campus Virchow Klinikum, Augustenburger Platz 1, Forum 4, D-13353 Berlin, Germany.
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