Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support

Hoover, Nancy G.; Heard, Michael L.; Reid, C.; Wagoner, Scott; Rogers, Kristine; Foland, Jason; Paden, Matthew L.; Fortenberry, James D.

doi:10.1007/s00134-008-1200-y

Cited by 106 publications

(86 citation statements)

References 22 publications

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“…Data from the present study 1) provide a current estimate of CHX contamination in commercially available IV bags and EC circuits and 2) clearly indicate that the effects of 210 g/l IV CHX (a concentration that conservatively approximates clinical exposure for EC patients) mirror the cardiovascular morbidities associated with EC: bradycardia/dysrhythmia (1,4,5,19,33,38), depressed ventricular contractility (1,2,4,5,8,11,18,19,24,33,38,39,41), low cardiac output (7,11,14,28,31), high systemic and pulmonary vascular resistance (7, 13, 18, 29 -31), hypotension/labile blood pressure (2,7,21), pulmonary hypertension (7, 29 -31), impaired neurological (baroreflex) function (3,5,34,38,39), and edema formation (20,32,39).…”

Section: Discussionmentioning

confidence: 99%

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

Thompson-Torgerson¹,

Champion²,

Santhanam³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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Extracorporeal circulation provides critical life support in the face of cardiopulmonary or renal failure, but it also introduces a host of unique morbidities characterized by edema formation, cardiac insufficiency, autonomic dysfunction, and altered vasomotor function. We tested the hypothesis that cyclohexanone (CHX), a solvent used in production of extracorporeal circuits and intravenous (IV) bags, leaches into the contained fluids and can replicate these clinical morbidities. Crystalloid fluid samples from circuits and IV bags were analyzed by gas chromatography-mass spectrometry to provide a range of clinical CHX exposure levels, revealing CHX contamination of sampled fluids (9.63-3,694 g/l). In vivo rat studies were conducted (n ϭ 49) to investigate the effects of a bolus IV infusion of CHX vs. saline alone on cardiovascular function, baroreflex responsiveness, and edema formation. Cardiovascular function was evaluated by cardiac output, heart rate, stroke volume, vascular resistance, arterial pressure, and ventricular contractility. Baroreflex function was assessed by mean femoral arterial pressure responses to bilateral carotid occlusion. Edema formation was assessed by the ratio of wet to dry organ weights for lungs, liver, kidneys, and skin. CHX infusion led to systemic hypotension; pulmonary hypertension; depressed contractility, heart rate, stroke volume, and cardiac output; and elevated vascular resistance (P Ͻ 0.05). Mean arterial pressure responsiveness to carotid occlusion was dampened after CHX infusion (from ϩ17.25 Ϯ 1.8 to ϩ5.61 Ϯ 3.2 mmHg; P Ͻ 0.05). CHX infusion led to significantly higher wet-to-dry weight ratios vs. saline only (3.8 Ϯ 0.06 vs. 3.5 Ϯ 0.05; P Ͻ 0.05). CHX can reproduce clinical cardiovascular, neurological, and edema morbidities associated with extracorporeal circulatory treatment. ventricular contractility; autonomic nervous system; vasoconstriction; edema EXTRACORPOREAL CIRCULATION [EC; cardiopulmonary bypass, extracorporeal membrane oxygenation (ECMO), hemodialysis, hemofiltration] has become a primary tool in hospitals, providing critical life support in the face of cardiopulmonary or renal failure. However, EC also introduces a host of unique morbidities, including labile blood pressure, depressed cardiac output, ventricular dysfunction, arrhythmias, and major organ edema (1-2, 8, 17-19, 22, 31-33, 40). Although several randomized clinical trials have been conducted to minimize these and other effects of EC treatment (17), EC morbidity rates still remain high and represent a significant barrier to improved patient care, as evidenced by increased time in the intensive care unit (ICU) and on inotropic support.Cyclohexanone [CHX; C 6 H 10 (AO)] is an organic solvent used in the production of polyvinyl chloride (PVC) medical devices, including intravenous (IV) fluid bags and EC circuits. CHX easily migrates from PVC tubing and connections into fluids that come in contact with PVC (10, 12, 35, 37), irrespective of the type of IV fluid. CHX can leach from PVC bags and IV tub...

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Section: Discussionmentioning

confidence: 99%

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

Thompson-Torgerson¹,

Champion²,

Santhanam³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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“…[15] Many medical centers offer continuous RRT as the most manageable and effective method. [16] We chose CVVHF, which influences various aspects of the pathogenesis of MODS, inhibits its development and progression, and helps eliminate the medium molecular weight substances, thereby contributing to a decrease in inflammatory cascade activity. [17] In addition, the use of high volumes of replacement liquids (more than 30-35 mL/kg/h) can be of great importance for enhancing lymphatic transport between the intercellular space, tissues and blood and for reducing the activity of the inflammatory cascade.…”

Section: Cvvhf In Conjunction With Ecmo In Children With Critical Heamentioning

confidence: 99%

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Yaroustovsky¹,

Abramyan²,

Komardina³

et al. 2017

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How to cite this article: Yaroustovsky M, Abramyan M, Komardina E, Nazarova H. Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery. Vessel Plus 2017;1:49-60.Extracorporeal blood purification is becoming increasingly important in intensive therapy for multiple organ dysfunction syndrome (MODS) and sepsis, considering all of their pathophysiological aspects. The results of treatment, particularly in children, considering their anatomical and physiological features, are related to the severity and progression of organ failure, the indications that are found, the choice of method, and the timely initiation of blood purification. Multiple organ support therapy is the aim of introducing and applying blood purification today. Various extracorporeal blood purification techniques directly affect the molecular and electrolyte composition of blood and influence all structures of the human body, which can allow us to correct, recover, replace and maintain homeostasis in MODS. The potential of new extracorporeal molecular technologies allows their successful use in severe cardiac and respiratory failure, acute kidney injury and hepatic dysfunction and in complex therapy for severe infections and sepsis and extreme metabolic violations. Adult and pediatric patients after cardiac surgery with cardiopulmonary bypass form a special cohort that often requires the application of various intra-and extracorporeal techniques due to the development of MODS, infections and sepsis in the postoperative period. Key words:Extracorporeal blood purification, acute kidney injury, acute liver failure, extracorporeal membrane oxygenation, sepsis, selective lipopolysaccharideadsorption, critical condition, cardiovascular surgery ABSTRACT Article history:

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“…5). In a study on fluid management with continuous venovenous hemofiltration in pediatric patients receiving ECMO support, Hoover et al [79] showed that the use of continuous venovenous hemofiltration in ECMO was associated with improved fluid balance, increased caloric intake and less diuretics administration, compared with case-matched ECMO controls. However, unlike the venovenous ECCO2R machines, potential implications of attaching continuous RRT to ECMO circuit should be carefully considered and is best done at centers specialized in these techniques.…”

Section: Pulmonary/renal Support – Mostmentioning

confidence: 99%

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Kaushik

Wojewódzka-Żelezniakowicz

Cruz

et al. 2012

Blood Purif

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Extracorporeal organ support in patients with dysfunction of vital organs like the kidney, heart, and liver has proven helpful in bridging the patients to recovery or more definitive therapy. Mechanical ventilation in patients with respiratory failure, although indispensable, has been associated with worsening injury to the lungs, termed ventilator-induced lung injury. Application of lung-protective ventilation strategies are limited by inevitable hypercapnia and hypercapnic acidosis. Various alternative extracorporeal strategies, proposed more than 30 years ago, to combat hypercapnia are now more readily available. In particular, the venovenous approach to effective carbon dioxide removal, which involves minimal invasiveness comparable to renal replacement therapy, appears to be very promising. The clinical applications of these extracorporeal carbon dioxide removal therapies may extend beyond just lung protection in ventilated patients. This article summarizes the rationale, technology and clinical application of various extracorporeal lung assist techniques available for clinical use, and some of the future perspectives in the field.

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Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support

Abstract: Use of CVVH in ECMO was associated with improved fluid balance and caloric intake and less diuretics than in case-matched ECMO controls.

Cited by 106 publications

References 22 publications

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

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