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1.
Clin Appl Thromb Hemost ; 27: 1076029620982374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571008

RESUMO

Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.


Assuntos
Plaquetas/metabolismo , Ponte Cardiopulmonar/instrumentação , Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Transtornos Hemostáticos/etiologia , Oxigenadores de Membrana , Implantação de Prótese/instrumentação , Animais , Plaquetas/patologia , Ponte Cardiopulmonar/efeitos adversos , Micropartículas Derivadas de Células/metabolismo , Micropartículas Derivadas de Células/patologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemólise , Transtornos Hemostáticos/sangue , Humanos , Ativação Plaquetária , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Medição de Risco , Fatores de Risco , Estresse Mecânico , Resultado do Tratamento
2.
Int. j. artif. organs ; : 1-2, Jan. 2021.
Artigo em Inglês | Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1147026

RESUMO

It is established that coronaviruses are transmitted most through aerosols produced when an infected individual coughs or sneezes.1 Although there is no clear evidence of person-to-person airborne transmission, it is possible that part of this component could be due to microscopic respiratory droplets at short to medium distances (up to several meters, or room scale) and deposits from respiratory droplets on surfaces.2,3 However, recent studies revealed that infected patients can potentially be a source of the virus not only through respiratory but also fecal­oral or body fluid routes, raising also the theoretical possibility of bloodborne transmission.4 Based on these arguments, the possibility has also been raised of some equipment that could be a new source of transmission, like the membranes used for extracorporeal oxygenation, which act the same as lungs and also have a direct contact with the blood. Most centers worldwide report a reduction in the cardiac procedures due to the pandemic, however emergency surgeries with conventional cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) procedures have been performed every day. Despite guidelines and modifications for operating theatre preparation for the management of suspected or confirmed SARS-CoV-2 patients submitted to cardiac surgery, many aspects still need to be clarified.5 Potential risk of transmission with these membranes exists, so much that Dres et al.6 reported a study evaluating the risks of SARS-CoV-2 dissemination through membranes used for extra corporeal organ support in critically ill patients, within 48 h after ECMO and continuous renal replacement therapy (CRRT) initiation. They investigated whether SARS-CoV-2 RNA was detected in the dialysis effluent fluid or in the condensate collected from the ECMO membrane gas outlet, when the virus was present in the lower respiratory tract and the plasma. Results showed that in 25 patients on veno-venous ECMO, SARSCoV-2 RNA was not detected in the membrane oxygenator gas outlet condensate in any of 25 patients of whom 13 were plasma RNA positive. Also, they were not able to measure any SARS-CoV-2 RNA in the dialysate of those patients who additionally were treated by CRRT.


Assuntos
Oxigenadores de Membrana , Coronavirus , Aerossóis , Membranas
3.
ASAIO J ; 66(10): 1076-1078, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33136591

RESUMO

With the massive influx of patients during COVID-19 pandemic into intensive care unit, resources have quickly been stretched to the limit, including extracorporeal membrane oxygenation (ECMO). Gas blender attached to ECMO is used to allow precise adjustment of characteristics of fresh gas flow, that is, blood oxygen delivery and carbon dioxide removal. To cope with the gas blender shortage, we describe a back-up system set up in our French tertiary referral ECMO center using air and oxygen flowmeters. A table has been created to facilitate medical prescription but also nurse monitoring. This extraordinary situation forces physicians to adapt medical devices, and that could be useful in future viral pandemics.


Assuntos
Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenadores de Membrana/provisão & distribução , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Pandemias
4.
J Extra Corpor Technol ; 52(3): 242-244, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32981963

RESUMO

We are presenting a case of successful resuscitation during accidental rupture of a venoarterial extracorporeal membrane oxygenator after surgical pulmonary embolectomy. This article reports a rare complication related to the mechanical circulatory support and its successful management.


Assuntos
Oxigenação por Membrana Extracorpórea , Oxigenadores de Membrana , Embolectomia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Doença Iatrogênica , Choque Cardiogênico
7.
Am J Respir Crit Care Med ; 202(3): 383-392, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32293914

RESUMO

Rationale: Mesenchymal stromal cell (MSC) therapy is a promising intervention for acute respiratory distress syndrome (ARDS), although trials to date have not investigated its use alongside extracorporeal membrane oxygenation (ECMO). Recent preclinical studies have suggested that combining these interventions may attenuate the efficacy of ECMO.Objectives: To determine the safety and efficacy of MSC therapy in a model of ARDS and ECMO.Methods: ARDS was induced in 14 sheep, after which they were established on venovenous ECMO. Subsequently, they received either endobronchial induced pluripotent stem cell-derived human MSCs (hMSCs) (n = 7) or cell-free carrier vehicle (vehicle control; n = 7). During ECMO, a low Vt ventilation strategy was employed in addition to protocolized hemodynamic support. Animals were monitored and supported for 24 hours. Lung tissue, bronchoalveolar fluid, and plasma were analyzed, in addition to continuous respiratory and hemodynamic monitoring.Measurements and Main Results: The administration of hMSCs did not improve oxygenation (PaO2/FiO2 mean difference = -146 mm Hg; P = 0.076) or pulmonary function. However, histological evidence of lung injury (lung injury score mean difference = -0.07; P = 0.04) and BAL IL-8 were reduced. In addition, hMSC-treated animals had a significantly lower cumulative requirement for vasopressor. Despite endobronchial administration, animals treated with hMSCs had a significant elevation in transmembrane oxygenator pressure gradients. This was accompanied by more pulmonary artery thromboses and adherent hMSCs found on explanted oxygenator fibers.Conclusions: Endobronchial hMSC therapy in an ovine model of ARDS and ECMO can impair membrane oxygenator function and does not improve oxygenation. These data do not recommend the safe use of hMSCs during venovenous ECMO.


Assuntos
Lesão Pulmonar Aguda/patologia , Oxigenação por Membrana Extracorpórea , Pulmão/patologia , Transplante de Células-Tronco Mesenquimais , /terapia , Lesão Pulmonar Aguda/imunologia , Animais , Líquido da Lavagem Broncoalveolar/imunologia , Adesão Celular , Modelos Animais de Doenças , Humanos , Células-Tronco Pluripotentes Induzidas , Interleucina-8/imunologia , Pulmão/imunologia , Oxigenadores de Membrana , Artéria Pulmonar , Distribuição Aleatória , Respiração Artificial , /patologia , Ovinos , Carneiro Doméstico , Trombose/patologia , Vasoconstritores/uso terapêutico
8.
Methodist Debakey Cardiovasc J ; 16(1): 27-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32280415

RESUMO

Cardiogenic shock is associated with significant morbidity and mortality, and clinicians have increasingly used short-term mechanical circulatory support (MCS) over the last 15 years to manage outcomes. In general, the provision of greater hemodynamic support comes with device platforms that are more complex and potentially associated with more adverse events. In this review, we compare and contrast the available percutaneous and surgically placed device types used in cardiogenic shock and discuss the associated clinical and hemodynamic data to support device use.


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Hemodinâmica , Balão Intra-Aórtico/instrumentação , Oxigenadores de Membrana , Choque Cardiogênico/terapia , Função Ventricular , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/mortalidade , Recuperação de Função Fisiológica , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento
9.
J Extra Corpor Technol ; 52(1): 22-26, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32280141

RESUMO

To remove gaseous microemboli (GME) using an oxygenator with an integrated arterial filter, it is recommended by some manufacturers to purge the oxygenator as an additional safety feature while on bypass. In this in vitro study, we evaluated whether purging of oxygenators with an integrated arterial filter is efficient in reducing GME. Five different types of commercially available contemporary oxygenators with an integrated arterial filter based on progressive filter filtration (1), cascade filtration (1), screen filtration (2), or self-venting (1) were tested for their efficiency in removing GME while keeping the purge line open or closed. A bubble counter was used for pre- and post-oxygenator GME signaling, from which the filter efficiency was computed. Freshly drawn heparinized porcine blood was used at blood flow rates of 3 and 5 L/min. Three units of each oxygenator were tested with its specific reservoir at a fixed volume level of 1,500 mL. GME load was introduced into the venous line at 1,000 mL air/min. Measurements started as soon as GME were detected by the pre-oxygenator probe and then continued for 1 minute. There was no statistically significant difference in filter efficiency between the purged and non-purged groups for specific oxygenators. At a blood flow of 3 L/min, the average filter efficiency stayed approximately invariable when comparing the non-purged and purged groups, where 89.1-88.2% indicated the largest difference between the groups. At a blood flow rate of 5 L/min, the filter efficiency changed in one screen filter group from an average of 55.7% in the non-purged group to 42.4% in the purged group. Other filter efficiencies at the blood flow rate of 5 L/min for non-purged compared with purged groups were, respectively, 98.0 vs. 98.0% (screen filtration), 88.6 vs. 85.8% (self-venting filtration), 82.8 vs. 75.5% (progressive filter filtration), and 65.4 vs. 65.1% (cascade filtration). Based on these results, purging while confronted with continuous GME challenge did not result in an increased filter efficiency.


Assuntos
Artérias , Ponte Cardiopulmonar , Desenho de Equipamento , Oxigenadores de Membrana
10.
J Extra Corpor Technol ; 52(1): 43-51, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32280143

RESUMO

Creation of water condensation in blood oxygenators is a phenomenon that is constantly present during cardiopulmonary bypass and in medium- to long-term extracorporeal life support. Clinical observation of condensation at the oxygenator exit is still a common event normally associated with sudden cooling of the gas flow proximal to the outlet cover (after exiting the fiber bundle), where the warming effect of blood is no longer present. Condensation could progressively obstruct a certain number of fibers, reducing the efficiency of gaseous exchange in the membrane of the oxygenator surface. The study included 48 patients divided into four oxygenator groups of 12 each: group 1 used an Inspire 6 F oxygenator from Livanova; group 2, an Affinity Fusion from Medtronic; group 3, an Alone from Eurosets, and group 4, an ECMO Alone from Eurosets; while the last group used an ECMO Alone oxygenator from Eurosets with polymethylpentene fiber. Each group of oxygenators comprising 12 patients were divided into two groups, namely, A and B, with six patients in each group. Group A used mild hypothermia during the procedure, and group B of six patients used normothermia; Groups A and B were further subdivided into four subgroups: A1, A2, B1, and B2, each consists of three patients; subgroups A1 and B1 used negative aspiration (-8 mmHg) measuring humidity (%) and temperature (°C) in the gas oxygenator output; consequently, a measurement system was necessary to be created; Subgroups A2 and B2 did not use negative aspiration in the oxygenator outlet. No statistically significant difference for PaO2 and humidity values was found in polypropylene and polymethylpentene oxygenators with mild hypothermia management with vacuum and without vacuum in the gas outlet in the first 60 minutes and 60 minutes later during cardiopulmonary bypass. In normothermia, a statistically significant difference in the PaO2-humidity relationship was observed with polypropylene and polymethylpentene fiber models. Results of this study show an inversely proportional correlation between gas exchange and condensation in statistically significant values during the use of normothermia and a reduction in oxygenation performance, in polypropylene and polymethylpentene fiber oxygenators.


Assuntos
Oxigenação por Membrana Extracorpórea , Oxigenadores de Membrana , Idoso , Ponte Cardiopulmonar , Desenho de Equipamento , Humanos , Oxigênio , Oxigenadores , Água
11.
Sci Rep ; 10(1): 6063, 2020 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-32269237

RESUMO

With the aim to explore innovative tools for organ preservation, especially in marginal organs, we hereby describe a clinical trial of ex-vivo hypothermic oxygenated perfusion (HOPE) in the field of liver (LT) and kidney transplantation (KT) from Extended Criteria Donors (ECD) after brain death. A matched-case analysis of donor and recipient variables was developed: 10 HOPE-ECD livers and kidneys (HOPE-L and HOPE-K) were matched 1:3 with livers and kidneys preserved with static cold storage (SCS-L and SCS-K). HOPE and SCS groups resulted with similar basal characteristics, both for recipients and donors. Cumulative liver and kidney graft dysfunction were 10% (HOPE L-K) vs. 31.7%, in SCS group (p = 0.05). Primary non-function was 3.3% for SCS-L vs. 0% for HOPE-L. No primary non-function was reported in HOPE-K and SCS-K. Median peak aspartate aminotransferase within 7-days post-LT was significantly higher in SCS-L when compared to HOPE-L (637 vs.344 U/L, p = 0.007). Graft survival at 1-year post-transplant was 93.3% for SCS-L vs. 100% of HOPE-L and 90% for SCS-K vs. 100% of HOPE-K. Clinical outcomes support our hypothesis of machine perfusion being a safe and effective system to reduce ischemic preservation injuries in KT and in LT.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/instrumentação , Transplante de Fígado/instrumentação , Preservação de Órgãos/instrumentação , Perfusão/instrumentação , Doadores de Tecidos , Idoso , Aspartato Aminotransferases/metabolismo , Temperatura Baixa , Feminino , Humanos , Bombas de Infusão/efeitos adversos , Bombas de Infusão/normas , Rim/metabolismo , Transplante de Rim/métodos , Fígado/metabolismo , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Preservação de Órgãos/métodos , Oxigenadores de Membrana/efeitos adversos , Oxigenadores de Membrana/normas , Perfusão/métodos
12.
Circ J ; 84(4): 533-541, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-32147603

RESUMO

Advances in surgical and medical care of children born with heart defects have led to the emergence of a unique subgroup of young adults known as adults with congenital heart disease (ACHD). Heart failure (HF) is the leading cause of mortality and morbidity in this subset. Management of HF is challenging in these patients owing to inherent structural variations with their associated physiological consequences. Heart transplantation is of limited utility in this group either because of donor shortage or associated comorbidities that make these patients ineligible for transplantation. Mechanical circulatory support (MCS) devices have evolved as an alternative treatment modality in supporting the failing myocardium of this population, but are often used less frequently than in those with a structurally normal heart because of the unique anatomical and physiological variations. These variations create a need to gather adequate knowledge on how best to support the hearts of ACHD patients in order to reduce mortality and morbidity. This review presents clinical experience with MCS in ACHD patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Oxigenação por Membrana Extracorpórea/instrumentação , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Balão Intra-Aórtico/instrumentação , Oxigenadores de Membrana , Sobreviventes , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/mortalidade , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto Jovem
14.
Circ Heart Fail ; 13(3): e005853, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32164431

RESUMO

BACKGROUND: Limited progress has been made in the management of cardiogenic shock (CS). Morbidity and mortality of refractory CS remain high. The effects of mechanical circulatory support (MCS) are promising, although many aspects are elusive. We evaluated efficacy and safety of early combined MCS (Impella microaxial pump + venoarterial extracorporeal membrane oxygenation [VA-ECMO]) in refractory CS and aimed to determine factors for decision-making in combined MCS. METHODS AND RESULTS: We analyzed 69 consecutive patients with refractory CS from our registry requiring combined MCS. In 12 cases, therapy was actively withdrawn according to patient's will. Patients were severely sick (Survival After Venoarterial ECMO score mean±SD, -8.9±4.4) predicting 30% in-hospital survival; ventilation 94%, dialysis 56%. Impella pumps and VA-ECMO were combined early (duration of combined MCS: median 94 hours; interquartile range, 49-150 hours). Early MCS escalation stabilized patients rapidly, reducing number and doses of catecholamines (P<0.05 versus baseline) while hemodynamics improved. Reflecting an improved microcirculation, lactate levels normalized within 24 hours (P<0.05 versus baseline). Despite refractory CS and disease severity, survival was favorable (on MCS 61%, 30 days 49%, 6 months 40%). In multivariate Cox-regression, duration of shock-to-first device (hours, hazard ratio, 1.05 [95% CI, 1.01-1.08]; P=0.007) and lactate levels after 12 hours of MCS (hazard ratio, 1.28 [95% CI, 1.09-1.51]; P=0.002) independently predicted survival. Additional right ventricular failure predisposed to futility (hazard ratio, 8.48 [95% CI, 1.85-38.91]; P=0.006). CONCLUSIONS: The early and consequent combination of MCS by Impella microaxial pumps and VA-ECMO enables stabilization and may rescue high-risk patients with refractory CS at low overall risk. Independent predictors of survival may guide prognostication, decision-making, and allocation of medical resources.


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Hemodinâmica , Oxigenadores de Membrana , Implantação de Prótese/instrumentação , Choque Cardiogênico/terapia , Função Ventricular Esquerda , Função Ventricular Direita , Adulto , Idoso , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
Artif Organs ; 44(3): 268-277, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31408537

RESUMO

Occurrence of microbubbles (MB) is a major problem during venoarterial extracorporeal life support (ECLS) with partially severe clinical complications. The aim of this study was to establish an in vitro ECLS setup for the generation and detection of MB. Furthermore, we assessed different MB elimination strategies. Patient and ECLS circuit were simulated using reservoirs, a centrifugal pump, a membrane oxygenator, and an occluder (modified roller pump). The system was primed with a glycerin solution of 44%. Three different revolution speeds (2500, 3000, and 3400 rpm) were applied. For MB generation, the inflow line of the pump was either statically or dynamically (15 rpm) occluded. A bubble counter was used for MB detection. The effectiveness of the oxygenator and dynamic bubble traps (DBTs) was evaluated in regard to MB elimination capacities. MB generation was highly dependent on negative pressure at the inflow line. Increasing revolution speeds and restriction of the inflow led to increased MB activity. The significant difference between inflow and outflow MB volume identified the centrifugal pump as a main source. We could show that the oxygenator's ability to withhold larger MB is limited. The application of one or multiple DBTs leads to a significant reduction in MB count and overall gas volume. The application of DBT can significantly reduce the overall gas volume, especially at high flow rates. Moreover, large MB can effectively be broken down for faster absorption. In general, the incidence of MBs is significantly dependent on pump speed and restriction of the inflow. The centrifugal pump was identified as a major source of MB generation.


Assuntos
Embolia Aérea/etiologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Embolia Aérea/prevenção & controle , Desenho de Equipamento , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Oxigenadores de Membrana/efeitos adversos , Pressão
19.
Artif Organs ; 44(1): 28-39, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30512218

RESUMO

The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different vacuum-assisted venous drainage (VAVD) vacuum levels and venous reservoir levels in a neonatal cardiopulmonary bypass circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 arterial filter to Capiox FX05 oxygenator with integrated arterial filter. Arterial cannula flow rate to the patient was held at 500 mL/min and temperature maintained at 32°C, while VAVD vacuum levels (0 mm Hg, -15 mm Hg, -30 mm Hg, -45 mm Hg, -60 mm Hg) and venous reservoir levels (50 mL, 200 mL) were evaluated in both oxygenators. Hemodynamic parameters measuring flow, pressure, and total hemodynamic energy were made in real time using a custom-made data acquisition system and Labview software. Nearly 10 cc bolus of air was injected into the venous line and gaseous microemboli detected using an Emboli Detection and Classification Quantifier. Diverted blood flow via the arterial filter's purge line and mean pressures increased with increasing VAVD levels (P < 0.01). Mean pressures were lower with lower venous reservoir levels and were greater in RX05 groups compared to FX05 (P < 0.01). Microemboli detected at the preoxygenator site increased with higher VAVD vacuum levels and lower venous reservoir levels (P < 0.01). The amount of microemboli captured by the FX05 oxygenator with integrated arterial filter was greater than by the RX05 oxygenator alone, although both oxygenators were able to clear microemboli before reaching the pseudo-patient.


Assuntos
Ponte Cardiopulmonar/instrumentação , Hemodinâmica , Oxigenadores de Membrana , Drenagem/instrumentação , Desenho de Equipamento , Humanos , Recém-Nascido , Modelos Cardiovasculares , Vácuo , Dispositivos de Acesso Vascular
20.
Pediatr Crit Care Med ; 21(3): 276-282, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31688715

RESUMO

OBJECTIVES: To determine the oxygenator impact on alterations of ceftolozane/tazobactam in a contemporary neonatal/pediatric (1/4-inch) and adolescent/adult (3/8-inch) extracorporeal membrane oxygenation circuit including the Quadrox-i oxygenator (Maquet, Wayne, NJ). DESIGN: A 1/4-inch and 3/8-inch, simulated closed-loop extracorporeal membrane oxygenation circuits were prepared with a Quadrox-i pediatric and Quadrox-i adult oxygenator and blood primed. Additionally, 1/4-inch and 3/8-inch circuits were also prepared without an oxygenator in series. A one-time dose of ceftolozane/tazobactam was administered into the circuits and serial preoxygenator and postoxygenator concentrations were obtained at 5 minutes, 1, 2, 3, 4, 5, 6, and 24-hour time points. Ceftolozane/tazobactam was also maintained in a glass vial and samples were taken from the vial at the same time periods for control purposes to assess for spontaneous drug degradation SETTING:: A free-standing extracorporeal membrane oxygenation circuit. PATIENTS: None. INTERVENTIONS: Single-dose administration of ceftolozane/tazobactam into closed-loop extracorporeal membrane oxygenation circuits prepared with and without an oxygenator in series with serial preoxygenator, postoxygenator, and reference samples obtained for concentration determination over a 24-hour study period. MEASUREMENTS AND MAIN RESULTS: For the 1/4-inch circuit, there was approximately 92% ceftolozane and 22-25% tazobactam loss with the oxygenator in series and 19-30% ceftolozane and 31-34% tazobactam loss without an oxygenator in series at 24 hours. For the 3/8-inch circuit, there was approximately 85% ceftolozane and 29% tazobactam loss with the oxygenator in series and 25-27% ceftolozane and 23-26% tazobactam loss without an oxygenator in series at 24 hours. The reference ceftolozane and tazobactam concentrations remained relatively constant during the entire study period demonstrating the drug loss in each size of the extracorporeal membrane oxygenation circuit with or without an oxygenator was not a result of spontaneous drug degradation. CONCLUSIONS: This ex vivo investigation demonstrated substantial ceftolozane loss within an extracorporeal membrane oxygenation circuit with an oxygenator in series with both sizes of the Quadrox-i oxygenator at 24 hours and significant ceftolozane loss in the absence of an oxygenator. Tazobactam loss was similar regardless of the presence of an oxygenator. Further evaluations with multiple dose in vitro and in vivo investigations are needed before specific drug dosing recommendations can be made for clinical application with extracorporeal membrane oxygenation.


Assuntos
Antibacterianos/administração & dosagem , Cefalosporinas/administração & dosagem , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Oxigenadores de Membrana , Tazobactam/administração & dosagem , Adolescente , Adulto , Antibacterianos/farmacocinética , Cefalosporinas/farmacocinética , Criança , Pré-Escolar , Desenho de Equipamento , Humanos , Lactente , Recém-Nascido , Taxa de Depuração Metabólica , Tazobactam/farmacocinética , Adulto Jovem
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