IV Perflubron emulsion versus autologous transfusion in severe normovolemic anemia: effects on left ventricular perfusion and function

Häbler, O.; Kleen, M.; Hutter, Jörg; Podtschaske, Armin; Tiede, M; Kemming, Gregor; Welte, M.; Corso, Carlos Otávio; Batra, Sanjay; Keipert, Peter E.; Faithfull, Simon; Meßmer, K.

doi:10.1007/s004330050079

Cited by 38 publications

(24 citation statements)

References 42 publications

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“…Fluorocrit was assessed in the same capillaries used for Hct measurements by centrifugation (Readacrit Centrifuge, Clay Adams) and is given as a percentage, representing the length of PCF emulsion (indicated by the white color) in the centrifuged capillary tube relative to the entire length of the centrifuged whole blood (consisting of subsequent layers of plasma, cells, and PCF emulsion) (7).…”

Section: Methodsmentioning

confidence: 99%

“…The low oxygen-carrying capacity of fluorocarbons in normoxic tissue can be augmented by exposing the organism to normobaric 100% oxygen, an approach taken in all attempts to produce an oxygen-carrying blood substitute with this material (7,9). Fluorocarbons to be used as blood substitutes would presumably be used to remedy blood losses, decreased oxygencarrying capacity, and anemia in conditions of anemic hyperoxia.…”

mentioning

confidence: 99%

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Oxygen delivery and consumption in the microcirculation after extreme hemodilution with perfluorocarbons

Cabrales¹,

Tsai²,

Frangos³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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Intaglietta. Oxygen delivery and consumption in the microcirculation after extreme hemodilution with perfluorocarbons. Am J Physiol Heart Circ Physiol 287: H320 -H330, 2004; 10.1152/ajpheart.01166.2003.-The oxygen transport capacity of fluorocarbons was investigated in the hamster chamber window model microcirculation to determine the rate at which oxygen is delivered to the tissue in conditions of extreme hemodilution [hematocrit (Hct) 11%]. Hydroxyethlyl starch (HES 200; 200 kDa molecular mass) was used as a plasma expander for two isovolemic hemodilutions performed with 10% HES 200 until a Hct of 65%. A third step reduced the Hct to 75% of baseline and was performed with either HES 200 or a 60% perfluorocarbon (PFC) emulsion. Comparisons of HES 200-only-hemodiluted animals versus 4.2 g/kg PFC emulsion-hemodiluted animals were made at 21% and 100% normobaric oxygen ventilation. It was found that systemic and microvascular oxygen delivery was 25% and 400% higher in the PFC animals compared with HES 200 animals, respectively, showing that PFCs deliver oxygen to the tissue when combined with hyperoxic ventilation in the present experiments, with no evidence of vasoconstriction or impaired microvascular function. Oxygen ventilation (100%) led to a positive base excess for the PFC group (5.5 Ϯ 2.5 mmol/l) versus a negative balance (Ϫ0.8 Ϯ 1.4 mmol/l) for the HES 200 group, suggesting that microvascular findings corresponded to systemic events. hyperoxia; functional capillary density; oxygen-carrying capacity; blood substitutes; tissue oxygen delivery THE CORRECTION OF BLOOD LOSSES usually begins with the normalization of blood volume. The continued decrease of red blood cell (RBC) concentration is followed by the restoration of oxygen-carrying capacity. To date, this latter phase remains firmly within the purvey of blood transfusion medicine; however, alternative oxygen-carrying volume fluids such as modified hemoglobins (Hbs) and fluorocarbons have emerged in the past decade. Few of these materials have been objectively analyzed in terms of their transport properties at the level of the microscopic blood vessels, where the actual exchange of oxygen takes place, to determine if their properties lead to adequate transport processes at the cellular/tissue level (8).Fluorocarbons have been investigated by different approaches that extended to phase 3 clinical trials (9). These materials carry oxygen, are synthetic, and, in principle, are available in very large quantities at modest costs. This has tantalized investigators, medical practitioners, and business enterprises, because it could, in principle, lead to a convenient, largely available, and pathogen-free oxygen carrier. However, fluorocarbons only become miscible with water when emulsified with phospholipids (derived from egg yolk) and therefore are not completely synthetic. Furthermore, whereas Hb carries oxygen via a reversible chemical reaction, fluorocarbons carry oxygen as a function of their solubility; therefore, at the PO 2 s prevailing in the microcirc...

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Oxygen delivery and consumption in the microcirculation after extreme hemodilution with perfluorocarbons

Cabrales¹,

Tsai²,

Frangos³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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“…In addition, Habler at al. found that mixed-venous O2 partial pressure was higher in perflubron emulsion treated animals after hemodilution to a Hb of 7 g/dL than in control animals (18,19) and also left ventricular contractility was improved after perflubron emulsion administration at a Hb level of 3 g/dl (20). This might be explained by an augmented O2 delivery through very narrow capillaries where perflubron emulsion particles (<0.2 µm) but less so the relatively large red blood cell (7-8 µm) may penetrate and thereby increase local tissue oxygenation including the myocardium (13).…”

Section: Introductionmentioning

confidence: 99%

“…In patients mobilised with G-CSF (CE 7.36%; 0.8-29.7) the contamination was greater than in unmobilised donors (0.83%; 0.5-6.8; Mann-Whitney-U-Test CE p=0.011). The hct decreased from 32% (23-40) to 29% (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)) and the platelets from 194G/l (11-966) to 105G/l (6-594). The contamination with platelets was lower compared to our own historical group ( 290 apheresis with the Fenwal CS3000; CE 6.7% versus 22.1%).…”

Section: P207 Predepletion Of Thrombocytes Improves the Yield Of Thementioning

confidence: 99%

Abstacts

2002

Transfus Med Hemother

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“…In dogs initially hemodiluted on room-air ventilation to Hb 7 g/dl, subsequent hyperoxic ventilation allowed for further hemodilution to the extreme value of Hb 3 g/dl without encountering significant changes in tissue oxygenation ( fig. 5) [19] and cardiac performance [21]. Moreover, in pigs ventilated with room-air and diluted until the occurrence of manifest tissue hypoxia (Hb 2.6 g/dl), subsequent ventilation with 100% oxygen was not only able to effectively reverse tissue hypoxia ( fig.…”

Section: Experimental Datamentioning

confidence: 99%

Hyperoxia in Extreme Hemodilution

et al. 2002

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Intraoperative surgical blood loss is initially replaced by infusion of red cell-free, cristalloidal or colloidal solutions. When normovolemia is maintained the ensuing dilutional anemia is compensated by an increase of cardiac output and of arterial oxygen extraction. In the ideal case, a surgical blood loss can entirely be ‘bridged’ without transfusion by intraoperative normovolemic hemodilution. However major blood loss results in extreme hemodilution and the transfusion of red blood cells may finally become necessary to increase arterial oxygen content and to preserve tissue oxygenation. When transfusion has to be started before surgical control of bleeding has been achieved, parts of the red blood cells transfused will get lost, thereby increasing intraoperative transfusion needs. Beside red blood cell transfusion, arterial oxygen content can be rapidly increased by ventilating the patient with 100% oxygen (hyperoxic ventilation), thus enhancing the amount of physically dissolved oxygen in plasma (hyperoxia). In experimental and clinical studies hyperoxic ventilation has emerged as a simple, safe and effective intervention to enlarge the margin of safety for hemodynamic compensation and tissue oxygenation in hemodiluted subjects experiencing major bleeding. The hyperoxia-associated microcirculatory dysregulation and impaired tissue oxygenation known to take place in the presence of a physiologic hemoglobin concentration are not encountered in hemodiluted subjects. Hyperoxic hemodilution i.e. the combination of intraoperative extreme hemodilution and hyperoxic ventilation may therefore be considered a cost-effective, safe and efficient supplement to reduce allogeneic transfusion during surgical interventions associated with high blood losses. The vast majority of the experimental and clinical investigations this new concept is based on was initiated and performed under the guidance of Prof. Konrad Messmer.

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IV Perflubron emulsion versus autologous transfusion in severe normovolemic anemia: effects on left ventricular perfusion and function

Cited by 38 publications

References 42 publications

Oxygen delivery and consumption in the microcirculation after extreme hemodilution with perfluorocarbons

Oxygen delivery and consumption in the microcirculation after extreme hemodilution with perfluorocarbons

Abstacts

Hyperoxia in Extreme Hemodilution

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