Impact of different types of resuscitation fluids on coagulation and continuous venovenous hemofiltration hemocompatibility in a porcine model.

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.

Evaluation of a new large animal model for controlled intracranial pressure changes induced by capnoperitoneum.

BACKGROUND: A standardized large animal model for controlled ICP manipulation within a relevant range and repetitive ICP measurements is missing. We sought to develop such a model on the base of controlled IPP changes induced by capnoperitoneum. METHODS: We utilized six female pigs (mean body weight 59.5 ± 18.4 kg) for experiments. A ventricular catheter connected with a burr hole reservoir was implanted. ICP was measured directly as cm H2O within a riser tube after percutaneous cannulation of the reservoir. A noninvasive intraperitoneal pressure (IPP) measurement was established (intravesical). Animals were placed in lateral position and a capnoperitoneum was induced. Measurements of ICP, IPP, MAP and respiratory parameters were performed at baseline IPP and after CO2 insufflation to IPP levels of 20 and 30 mmHg. RESULTS: Baseline IPP in lateral position referenced to median line was 9.8 (±2) mm Hg, while corresponding ICP was 10 (±2.2) mm Hg. After IPP elevation to 20 mmHg, ICP increased to 18.8 (±1.9) mm Hg. At 30 mmHg IPP, ICP increased to 22.8 (±2.8) mm Hg. Except peak airway pressure, all other parameters were kept constantly. Mean ICP variation in the individual subject was 13.4 (±2.5) mm Hg, while a ICP range from minimum 9 to maximum 31 mmHg was documented. CONCLUSIONS: We report a large animal model that allows (1) repeated measurement of the ICP and (2) manipulation of the ICP within a large pressure range by controlled IPP changes due to capnoperitoneum.

Influence of different heparin concentrations on the results of in vitro investigations in plasmaseparation technology using capillary membrane filters.

Capillary membrane filters are devices commonly used for plasmapheresis and recirculating detoxification systems, including plasmaseparation units. Besides clinical trials and case reports, research on plasmafiltration techniques is carried out using in vitro systems. Notably, such hemoperfused in vitro systems require anticoagulation protocols suitable for investigating the clearance performance and hemocompatibility of a plasmafilter. This study analyzes how different heparin concentrations affect filtration performance and the hemocompatibility under conditions typically employed during in vitro experiments. Porcine blood from healthy slaughtered animals was used in an in vitro circuit. The blood collecting system was primed with heparin. Depending on the study group, blood was anticoagulated with either 2.5 IU/ml or 5 IU/ml heparin. The filters were n=10 PF1000N (effective membrane surface: 0.15 m2). For each experiment, the maximal permissible flow rate was established by determining the point where spontaneous hemolysis occurred and/or pressure values exceeded the highest limit of the pressure units on the apheresis monitor. Sieving coefficients of ten parameters, platelet counts, and coagulation patterns were determined at the lowest and highest blood flow (Qb) and filtration rates (Qf). Except for the activated clotting time (ACT), both anticoagulation protocols caused the blood to respond to its exposition to the plasmafilters concerning the activation and inhibition of the coagulation system. A significant decrease in platelet counts did not occur. There were sporadic differences in sieving properties between the groups. However, heparinization with 2.5 IU/ml resulted in unreproducible flow rate profiles, and pressure levels were higher than in the group with 5 IU/ml heparin. Compared to heparinization at 2.5 IU/ml, higher levels of heparinization stabilize rheological properties of the blood, and thereby increase the reliability of data obtained from plasmafiltration experiments carried out in vitro.