【体外膜肺ECMO精品课件】 Haemofiltration.pptVIP

Haemofiltration The History of Haemofiltration / Ultrafiltration The concept of removing fluid from the intravascular space of patients in renal failure, by the filtration of blood through an ultraporous membrane dates back to 1928. (Brull L. Realization de l’ultrafiltration in vivo. C R Soc Bid-Paris.) First clinical application in 1952 ( The Artificial Kidney- The efficacy of the dialyser; ultrafiltration for human use.) During the 1970’s Lee West Henderson began to introduce ultrafiltration during cardiac surgery. Haemodilution during CPB Benefits: Facilitate tissue perfusion Disadvantages: Decreased plasma colloidal oncotic pressure Reduced haematocrit Increased total body water and interstitual oedema in vital organs. Hypoxia Hypotension Hypocoagulation Myocardial and cerebral ischemia Why do we use a Haemofilter during CPB? Reverse haemodilution by removing plasma water and low molecular weight molecules directly across a semipermiable membrane using hydrostatic forces. Increase haematocrit – Increse oxygen delivery and organ perfusion Remove excess water (priming fluid and volume overloaded patients) Long duration of bypass, hypothermia and low body weight increase the risk of oedema and haemodilution. Note: Increasing the transmembrane pressure too much by occluding the outlet of the haemofilter could cause haemolysis. Why do we use a Haemofilter during CPB? Causes of Hyperkalemia during CPB Renal Impairment Cardioplegia (size of dose, continuous delivery?) Haemolysis Packed red cells Plasma potassium level is critical as it contributes to the recovery of normal sinus rhythm. Potassium may need to be added when a patient without increased potassium levels is haemofiltered. Circuit Design? Circuit Design Cont… Arterio-venous ultrafiltration From the recirculation line to the venous reservoir. From the arterial filter purge line to the venous reservoir. From the arterial line to the cadioplegia delivery line – using a heat exchanger for M