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  • Keckel, Tobias  (4)
  • Unger, Juliane K.  (4)
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  • 1
    Online Resource
    Online Resource
    Adverse Influence of Mixed Acidemia on the Biocompatibility of Continuous Veno‐Venous Hemofiltration With Respect to the Lungs
    Wiley ; 2013
    In:  Artificial Organs Vol. 37, No. 12 ( 2013-12), p. 1049-1058
    Details
    In: Artificial Organs, Wiley, Vol. 37, No. 12 ( 2013-12), p. 1049-1058
    Abstract: Experimental data indicate that hypercapnic adidosis has anti‐inflammatory effects. These anti‐inflammatory effects may even be a beneficial property in case of low tidal volume ventilation with consecutive hypercapnic acidosis. It is unclear whether these anti‐inflammatory effects predominate in critically ill patients who suffer from multiple pro‐ and anti‐inflammatory insults like extracorporeal organ support (pro‐inflammatory), metabolic acidosis (pro‐ and anti‐inflammatory), as well as hypoxia (pro‐inflammatory). Eighteen pigs were randomized into three groups, mechanically ventilated and connected to a continuous veno‐venous hemofiltration ( CVVH ) as pro‐inflammatory insult. A reference group with normal acid‐base state obtained normoventilation; a normoxemic acidemia group obtained normoxemic, mixed acidemia due to infusion of lactic and hyperchloremic acid and low tidal volume ventilation, and in a hypoxemic acidemia group the mixed acidemia was paralleled by hypoxemia. Lung histology including pulmonary leukocyte invasion, blood gases, blood cell counts, and hemodynamics were examined. The histological examination of the lungs of acidemic pigs showed a suppressed invasion of leukocytes and thinner alveolar walls compared with normoventilated and with hypoxemic pigs. Enhanced congestion and alveolar red blood cells ( RBCs ) combined with an increase of the pulmonary artery pressure were observed in acidemic pigs in comparison with the reference group. Normoxemic acidemia reduced the pro‐inflammatory reaction to the CVVH and mechanical ventilation in the ventilated lung areas in the form of pulmonary leukocyte invasion. However, this did not result in reduced scores for lung injury. Instead, an increased score for criteria which represent lung injury (congestion and alveolar RBCs ) was observed in acidemic pigs.
    Type of Medium: Online Resource
    ISSN: 0160-564X , 1525-1594
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.2013.37.issue-12
    DOI: 10.1111/aor.12104
    Language: English
    Publisher: Wiley
    Publication Date: 2013
    detail.hit.zdb_id: 2003825-2
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  • 2
    Online Resource
    Online Resource
    Prolonged Hypoxemia and Acidemia in Anesthetized Pigs: A Model for Research on Extracorporeal Organ Support in an Intensive Care Setting
    SAGE Publications ; 2010
    In:  The International Journal of Artificial Organs Vol. 33, No. 8 ( 2010-08), p. 544-552
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 33, No. 8 ( 2010-08), p. 544-552
    Abstract: Hypoxemia and acidemia (hypoxemia/acidemia) are serious complications in the critically ill and often occur in unstable patients exposed to extracorporeal organ support. Still, little is known about the biocompatibility interactions of hypoxemia/acidemia with extracorporeal circuits (ECC). Existing animal models often include the release of mediator cascades (sepsis-, lung injury models) or are based on small laboratory animals. We established a porcine model of hypoxemia/acidemia without an underlying disease and further challenged the situation with an extracorporeal circuit (ECC). Methods Hypoxemia/acidemia were induced (3.5 h) and maintained (3 h) in anesthetized pigs (40 kg) by a stepwise reduction in oxygenation, infusion of 0.4 mol·l −1 lactic and hydrochloric acid and by low tidal volume ventilation, targeting an P a O 2 〈 70 mmHg, S v O 2 〈 65%, pH ~ 7.2. Venovenous hemofiltration (CVVH) operated in recirculation mode without volume exchange was chosen to prove the suitability of the model for studies on ECCs under clinical conditions (ECC group, n=6). Another 6 animals underwent the same protocol except for the CVVH (reference group, n=6). Results The median P a O 2 during hypoxemia/acidemia was 62 mmHg, the median S v O 2 was 38%, and the median pH was 7.22. Hypoxemia/acidemia was successfully induced and maintained for 6.5 h in all pigs. CVVH could be performed for 3 h with blood flow rates up to 300 ml·min −1 and filtrate rates up to 60 ml·min −1 . Conclusions Our model provides hypoxemia/acidemia with blood gas values comparable to critically ill adult patients for several hours, during which it is possible to perform CVVH. Thus, it enables research on the biocompatibility reactions of extracorporeal circuits under intensive care conditions.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/039139881003300805
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 1474999-3
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  • 3
    Online Resource
    Online Resource
    Experimental High-Volume Hemofiltration With Predilutional Tris-Hydroxymethylaminomethane for Correction of Low Tidal Volume Ventilation-Induced Acidosis : CO2-REMOVAL WITH HEMOFILTRATION AND THAM
    Wiley ; 2011
    In:  Artificial Organs Vol. 35, No. 6 ( 2011-06), p. E108-E118
    Details
    In: Artificial Organs, Wiley, Vol. 35, No. 6 ( 2011-06), p. E108-E118
    Type of Medium: Online Resource
    ISSN: 0160-564X
    URL: Issue
    URL: Article
    DOI: 10.1111/aor.2011.35.issue-6
    DOI: 10.1111/j.1525-1594.2011.01204.x
    Language: English
    Publisher: Wiley
    Publication Date: 2011
    detail.hit.zdb_id: 2003825-2
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  • 4
    Online Resource
    Online Resource
    In a Porcine Model of Mixed Acidemia HES 130/0.4 May Support More Stable Hemodynamics during CVVH when Compared to Gelatine
    SAGE Publications ; 2012
    In:  The International Journal of Artificial Organs Vol. 35, No. 3 ( 2012-03), p. 180-190
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 35, No. 3 ( 2012-03), p. 180-190
    Abstract: Continuous veno-venous hemofiltration (CVVH) and mixed acidemia often occur simultaneously in critically ill patients. In a previous study in non-acidemic pigs we found that colloids and CVVH interact specifically with respect to hemodynamic stability, with favorable effects for 6% HES 130/0.4 versus 4% gelatine (GEL) infusion. In a porcine model, we investigated whether these colloid-type associated differences are still dominant under acidemic conditions. Methods We utilized 5 groups, a non-acidemic reference group receiving HES130 and CVVH; two acidemic groups receiving HES130 infusion (one with and one without CVVH); and two acidemic groups receiving GEL infusion (one with and one without CVVH). Mixed acidemia (pH ∼7.20) was established by low tidal volume ventilation and acid infusion. Stable acidemia/CVVH application was maintained for 3 hours. Hemodynamics and blood gases were recorded. Results Mixed acidemia led to a significant decrease in MAP and increase in MPAP in all groups. CVVH led to a further decrease in MAP but improved MPAP. During CVVH, HES130 ensured significantly higher MAP, Hb, and DO 2 values than GEL infusion. In the groups without CVVH these differences between HES 130/0.4 and GEL were not observed. Conclusions As in a previous study in non-acidemic pigs, we found a colloid-specific influence of HES130 versus GEL on hemodynamics during CVVH under acidemia. Again, HES130 infusion may lead to favorable effects. In contrast, acidemia without CVVH application was dominant over the impact of a respective colloid. The application of a CVVH seems to be an important trigger for the overall circulatory response to a particular colloid.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.5301/ijao.5000090
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 1474999-3
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