Balanced Ultrafiltration

Inflammatory Mediator Removal Capacity

Yulong Guan, Caihong Wan, Shigang Wang, Peng Sun, Cun Long

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Ultrafiltration with a hemoconcentrator may remove excess fluid load and alleviate tissue edema and has been universally adopted in extracorporeal circulation protocols during pediatric cardiac surgery. Balanced ultrafiltration is advocated to remove inflammatory mediators generated during surgery. However, whether balanced ultrafiltration can remove all or a portion of the inflammatory mediator load remains unclear. The inflammatory mediator removal capacity of zero-balanced ultrafiltration was measured during pediatric extracorporeal circulation in vitro. Extracorporeal circulation was composed of cardiotomy reservoir, D902 Lilliput 2 membrane oxygenator, and Capiox AF02 pediatric arterial line filter. The Hemoconcentrator BC 20 plus was placed between arterial purge line and oxygenator venous reservoir. Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24-28%. After 2h of extracorporeal circulation, zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100mmHg with Hoffman clamp. The rate of ultrafiltration (12mL/min) was controlled by ultrafiltrate outlet pressure. Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during the 45min of the experiment. Plasma and ultrafiltrate samples were drawn every 5min, and concentrations of inflammatory mediators including interleukin-1β (IL-1β), IL-6, IL-10, neutrophil elastase (NE), and tumor necrosis factor-α (TNF-α) were measured. All assayed inflammatory mediators were detected in the ultrafiltrate, demonstrating that the ultrafiltrator may remove inflammatory mediators. However, dynamic observations suggested that the concentration of NE was highest among the five inflammatory mediators in both plasma and ultrafiltrate (P<0.001). IL-1β had the lowest concentration in plasma, whereas the concentration of TNF-α was the lowest in ultrafiltrate (P<0.001). Concentrations of all inflammatory mediators in the ultrafiltrate did not increase linearly compared with those in plasma. The respective ultrafiltrate to plasma concentration and amount ratios indicated that the total removal effect of hemoconcentrator on the inflammatory mediators was 4.17±2.68% for IL-1β, 0.64±0.69% for IL-6, 0.24± 0.18% for IL-10, 2.84±1.65% for NE, and 0.51±0.81% for TNF-α, respectively. Balanced ultrafiltration may selectively remove inflammatory mediators from serum. Respective ratios of inflammatory mediators in ultrafiltrate compared with plasma, as well as total amount of inflammatory mediators in the ultrafiltrate suggest that balanced ultrafiltration removes a limited portion of the total inflammatory mediator load.

Original languageEnglish (US)
Pages (from-to)894-900
Number of pages7
JournalArtificial Organs
Volume36
Issue number10
DOIs
StatePublished - Oct 1 2012

Fingerprint

Ultrafiltration
Vascular Access Devices
Extracorporeal Circulation
Plasmas
Leukocyte Elastase
Pediatrics
Interleukin-1
Oxygenators
Tumor Necrosis Factor-alpha
Hematocrit
Interleukin-10
Surgery
Interleukin-6
Membrane Oxygenators
Networks (circuits)
Clamping devices
Thoracic Surgery
Edema
Arterial Pressure
Blood

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

Cite this

Guan, Yulong ; Wan, Caihong ; Wang, Shigang ; Sun, Peng ; Long, Cun. / Balanced Ultrafiltration : Inflammatory Mediator Removal Capacity. In: Artificial Organs. 2012 ; Vol. 36, No. 10. pp. 894-900.
@article{b294bde528b84f9bba8b533e5fcd9d1a,
title = "Balanced Ultrafiltration: Inflammatory Mediator Removal Capacity",
abstract = "Ultrafiltration with a hemoconcentrator may remove excess fluid load and alleviate tissue edema and has been universally adopted in extracorporeal circulation protocols during pediatric cardiac surgery. Balanced ultrafiltration is advocated to remove inflammatory mediators generated during surgery. However, whether balanced ultrafiltration can remove all or a portion of the inflammatory mediator load remains unclear. The inflammatory mediator removal capacity of zero-balanced ultrafiltration was measured during pediatric extracorporeal circulation in vitro. Extracorporeal circulation was composed of cardiotomy reservoir, D902 Lilliput 2 membrane oxygenator, and Capiox AF02 pediatric arterial line filter. The Hemoconcentrator BC 20 plus was placed between arterial purge line and oxygenator venous reservoir. Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24-28{\%}. After 2h of extracorporeal circulation, zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100mmHg with Hoffman clamp. The rate of ultrafiltration (12mL/min) was controlled by ultrafiltrate outlet pressure. Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during the 45min of the experiment. Plasma and ultrafiltrate samples were drawn every 5min, and concentrations of inflammatory mediators including interleukin-1β (IL-1β), IL-6, IL-10, neutrophil elastase (NE), and tumor necrosis factor-α (TNF-α) were measured. All assayed inflammatory mediators were detected in the ultrafiltrate, demonstrating that the ultrafiltrator may remove inflammatory mediators. However, dynamic observations suggested that the concentration of NE was highest among the five inflammatory mediators in both plasma and ultrafiltrate (P<0.001). IL-1β had the lowest concentration in plasma, whereas the concentration of TNF-α was the lowest in ultrafiltrate (P<0.001). Concentrations of all inflammatory mediators in the ultrafiltrate did not increase linearly compared with those in plasma. The respective ultrafiltrate to plasma concentration and amount ratios indicated that the total removal effect of hemoconcentrator on the inflammatory mediators was 4.17±2.68{\%} for IL-1β, 0.64±0.69{\%} for IL-6, 0.24± 0.18{\%} for IL-10, 2.84±1.65{\%} for NE, and 0.51±0.81{\%} for TNF-α, respectively. Balanced ultrafiltration may selectively remove inflammatory mediators from serum. Respective ratios of inflammatory mediators in ultrafiltrate compared with plasma, as well as total amount of inflammatory mediators in the ultrafiltrate suggest that balanced ultrafiltration removes a limited portion of the total inflammatory mediator load.",
author = "Yulong Guan and Caihong Wan and Shigang Wang and Peng Sun and Cun Long",
year = "2012",
month = "10",
day = "1",
doi = "10.1111/j.1525-1594.2012.01471.x",
language = "English (US)",
volume = "36",
pages = "894--900",
journal = "Artificial Organs",
issn = "0160-564X",
publisher = "Wiley-Blackwell",
number = "10",

}

Balanced Ultrafiltration : Inflammatory Mediator Removal Capacity. / Guan, Yulong; Wan, Caihong; Wang, Shigang; Sun, Peng; Long, Cun.

In: Artificial Organs, Vol. 36, No. 10, 01.10.2012, p. 894-900.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Balanced Ultrafiltration

T2 - Inflammatory Mediator Removal Capacity

AU - Guan, Yulong

AU - Wan, Caihong

AU - Wang, Shigang

AU - Sun, Peng

AU - Long, Cun

PY - 2012/10/1

Y1 - 2012/10/1

N2 - Ultrafiltration with a hemoconcentrator may remove excess fluid load and alleviate tissue edema and has been universally adopted in extracorporeal circulation protocols during pediatric cardiac surgery. Balanced ultrafiltration is advocated to remove inflammatory mediators generated during surgery. However, whether balanced ultrafiltration can remove all or a portion of the inflammatory mediator load remains unclear. The inflammatory mediator removal capacity of zero-balanced ultrafiltration was measured during pediatric extracorporeal circulation in vitro. Extracorporeal circulation was composed of cardiotomy reservoir, D902 Lilliput 2 membrane oxygenator, and Capiox AF02 pediatric arterial line filter. The Hemoconcentrator BC 20 plus was placed between arterial purge line and oxygenator venous reservoir. Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24-28%. After 2h of extracorporeal circulation, zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100mmHg with Hoffman clamp. The rate of ultrafiltration (12mL/min) was controlled by ultrafiltrate outlet pressure. Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during the 45min of the experiment. Plasma and ultrafiltrate samples were drawn every 5min, and concentrations of inflammatory mediators including interleukin-1β (IL-1β), IL-6, IL-10, neutrophil elastase (NE), and tumor necrosis factor-α (TNF-α) were measured. All assayed inflammatory mediators were detected in the ultrafiltrate, demonstrating that the ultrafiltrator may remove inflammatory mediators. However, dynamic observations suggested that the concentration of NE was highest among the five inflammatory mediators in both plasma and ultrafiltrate (P<0.001). IL-1β had the lowest concentration in plasma, whereas the concentration of TNF-α was the lowest in ultrafiltrate (P<0.001). Concentrations of all inflammatory mediators in the ultrafiltrate did not increase linearly compared with those in plasma. The respective ultrafiltrate to plasma concentration and amount ratios indicated that the total removal effect of hemoconcentrator on the inflammatory mediators was 4.17±2.68% for IL-1β, 0.64±0.69% for IL-6, 0.24± 0.18% for IL-10, 2.84±1.65% for NE, and 0.51±0.81% for TNF-α, respectively. Balanced ultrafiltration may selectively remove inflammatory mediators from serum. Respective ratios of inflammatory mediators in ultrafiltrate compared with plasma, as well as total amount of inflammatory mediators in the ultrafiltrate suggest that balanced ultrafiltration removes a limited portion of the total inflammatory mediator load.

AB - Ultrafiltration with a hemoconcentrator may remove excess fluid load and alleviate tissue edema and has been universally adopted in extracorporeal circulation protocols during pediatric cardiac surgery. Balanced ultrafiltration is advocated to remove inflammatory mediators generated during surgery. However, whether balanced ultrafiltration can remove all or a portion of the inflammatory mediator load remains unclear. The inflammatory mediator removal capacity of zero-balanced ultrafiltration was measured during pediatric extracorporeal circulation in vitro. Extracorporeal circulation was composed of cardiotomy reservoir, D902 Lilliput 2 membrane oxygenator, and Capiox AF02 pediatric arterial line filter. The Hemoconcentrator BC 20 plus was placed between arterial purge line and oxygenator venous reservoir. Fresh donor human whole blood was added into the circuit and mixed with Ringer's solution to obtain a final hematocrit of 24-28%. After 2h of extracorporeal circulation, zero-balanced ultrafiltration was initiated and arterial line pressure was maintained at approximately 100mmHg with Hoffman clamp. The rate of ultrafiltration (12mL/min) was controlled by ultrafiltrate outlet pressure. Identical volume of plasmaslyte A was dripped into the circuit to maintain stable hematocrit during the 45min of the experiment. Plasma and ultrafiltrate samples were drawn every 5min, and concentrations of inflammatory mediators including interleukin-1β (IL-1β), IL-6, IL-10, neutrophil elastase (NE), and tumor necrosis factor-α (TNF-α) were measured. All assayed inflammatory mediators were detected in the ultrafiltrate, demonstrating that the ultrafiltrator may remove inflammatory mediators. However, dynamic observations suggested that the concentration of NE was highest among the five inflammatory mediators in both plasma and ultrafiltrate (P<0.001). IL-1β had the lowest concentration in plasma, whereas the concentration of TNF-α was the lowest in ultrafiltrate (P<0.001). Concentrations of all inflammatory mediators in the ultrafiltrate did not increase linearly compared with those in plasma. The respective ultrafiltrate to plasma concentration and amount ratios indicated that the total removal effect of hemoconcentrator on the inflammatory mediators was 4.17±2.68% for IL-1β, 0.64±0.69% for IL-6, 0.24± 0.18% for IL-10, 2.84±1.65% for NE, and 0.51±0.81% for TNF-α, respectively. Balanced ultrafiltration may selectively remove inflammatory mediators from serum. Respective ratios of inflammatory mediators in ultrafiltrate compared with plasma, as well as total amount of inflammatory mediators in the ultrafiltrate suggest that balanced ultrafiltration removes a limited portion of the total inflammatory mediator load.

UR - http://www.scopus.com/inward/record.url?scp=84867208543&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867208543&partnerID=8YFLogxK

U2 - 10.1111/j.1525-1594.2012.01471.x

DO - 10.1111/j.1525-1594.2012.01471.x

M3 - Article

VL - 36

SP - 894

EP - 900

JO - Artificial Organs

JF - Artificial Organs

SN - 0160-564X

IS - 10

ER -