Evidence for Pulmonary Microembolization during Hemodialysis

Bischel, Margaret D.; Scoles, Brian; Mohler, John G.

doi:10.1378/chest.67.3.335

Cited by 85 publications

(33 citation statements)

References 5 publications

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“…The formation and transport of bubbles inside the blood vessels can have exogenous origin, when air is injected in the blood stream, or endogenous origin when gas bubbles form inside the blood stream. Bubbles from exogenous origin include bubbles resulting from medical proceedings such as surgeries (Borger et al 2001, Abu-Omar et al 2004, hemodialysis (Bischel et al 1975) and gas embolotherapy (Samuel et al 2012). Bubbles from endogenous origin comprise the formation of bubbles by cavitation in heart valves (Deklunder et al 1998, Milo et al 2003 and when pressure decreases abruptly in scuba diving (Papadopoulou et al 2013), astronaut extra vehicular activities (Karlsson et al 2009) or in high altitude flight (Foster and Butler 2009).…”

Section: Introductionmentioning

confidence: 99%

Microbubble moving in blood flow in microchannels: effect on the cell-free layer and cell local concentration

Bento

Sousa

Yaginuma

et al. 2017

Biomed Microdevices

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Gas embolisms can hinder blood flow and lead to occlusion of the vessels and ischemia. Bubbles in microvessels circulate as tubular bubbles (Taylor bubbles) and can be trapped, blocking the normal flow of blood. To understand how Taylor bubbles flow in microcirculation, in particular, how bubbles disturb the blood flow at the scale of blood cells, experiments were performed in microchannels at a low Capillary number. Bubbles moving with a stream of in vitro blood were filmed with the help of a high-speed camera. Cell-free layers (CFLs) were observed downstream of the bubble, near the microchannel walls and along the centerline, and their thicknesses were quantified. Upstream to the bubble, the cell concentration is higher and CFLs are less clear. While just upstream of the bubble the maximum RBC concentration happens at positions closest to the wall, downstream the maximum is in an intermediate region between the centerline and the wall. Bubbles within microchannels promote complex spatio-temporal variations of the CFL thickness along the microchannel with significant relevance for local rheology and transport processes. The phenomenon is explained by the flow pattern characteristic of low Capillary number flows. Spatio-temporal variations of blood rheology may have an important role in bubble trapping and dislodging.

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Section: Introductionmentioning

confidence: 99%

Microbubble moving in blood flow in microchannels: effect on the cell-free layer and cell local concentration

Bento

Sousa

Yaginuma

et al. 2017

Biomed Microdevices

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“…There is longstanding evidence that microemboli are produced in HD circuits and can produce end-organ pathology [8]. Microemboli (platelet aggregates or gaseous microbubbles) have been identified in the arteriovenous fistulae of HD patients [9].…”

Section: Introductionmentioning

confidence: 99%

Does a Patent Foramen Ovale Influence Cognitive Function in Dialysis Patients?

George¹,

Holt

Medford

et al. 2013

Nephron Clin Pract

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Background: Patients with chronic kidney disease on dialysis treatment have poorer cognitive function than age- and sex-matched controls. One proposed mechanism is cerebral microembolisation due to material from the dialysis circuit crossing a patent foramen ovale (PFO). Methods: Cognitive testing was carried out in haemodialysis (HD) patients and peritoneal dialysis (PD) patients. Transthoracic echocardiography was used to identify PFO. Follow-up testing 1 year later enabled comparison of cognitive decline between patients with and without a PFO, and between those undergoing different dialysis modalities. Results: 80 patients (aged 60.4 ± 15.0 years) were recruited (51 HD patients and 29 PD controls). A PFO was found in 21% of patients. 83% of dialysis patients suffered a decline in one or more cognitive function tests over 1 year. There was a significant difference in only one test between HD patients with or without a PFO. PD patients showed a more rapid cognitive decline than those on HD. Conclusions: Cognitive decline in dialysis patients is rapid and affects most patients. The presence of a PFO made only subtle differences to the rates of cognitive decline during 1 year of follow-up. Patients with a PFO should not be prevented from considering HD because of concerns of cerebral decline due to microembolisation.

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“…This hypothesis appeared strengthened by the fact that microfiltration of blood returning to the patient decreased hypoxemia. However, Aurigemma et al [7], using several different types of dialyzers and microfilters of even smaller pore size than those employed by Bischel et al [8], were unable to con firm the findings, since hypoxemia occurred despite mi crofiltration of venous blood. These authors noted, how ever, that hypoxemia did not develop when carbon diox ide was bubbled in the dialysate [7] and suggested that hypoxemia was due to hypoventilation secondary to loss of carbon dioxide into the dialysis bath (see below).…”

Section: Pulmonary Microembolizationmentioning

confidence: 94%

“…In 1975, Bischel et al [8] suggested that microemboli of particulate material -aggregates of platelets, leuko cytes, and fibrin -originating from the interaction be tween blood and the extracorporeal circuit might be responsible for the hypoxemia. This hypothesis appeared strengthened by the fact that microfiltration of blood returning to the patient decreased hypoxemia.…”

Section: Pulmonary Microembolizationmentioning

confidence: 99%