Assessment of Current Continuous Hemofiltration Systems and Development of a Novel Accurate Fluid Management System for Use in Extracorporeal Membrane Oxygenation

2008 ◽  
Vol 2 (3) ◽  
Author(s):  
Philippe Sucosky ◽  
Lakshmi P. Dasi ◽  
Matthew L. Paden ◽  
James D. Fortenberry ◽  
Ajit P. Yoganathan
Keyword(s):  
Fluid Flow ◽  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Fluid Balance ◽  
Management System ◽  
Fluid Management ◽  
Flow Rates ◽  
Fluid Removal ◽  
Replacement Fluid ◽  
Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) with a renal replacement therapy such as continuous venovenous hemofiltration (CVVH) provides life-saving temporary heart and lung, and renal support in pediatric and neonatal intensive care units. However, studies have shown that this approach may be hampered due to the potentially inaccurate fluid delivery∕drainage of current intravenous (IV) fluid pumps, creating potential for excessive fluid removal and undesired degrees of dehydration. We present a simple and novel accurate fluid management system capable of working against the high volume flow and pressures typically seen in patients on ECMO. The accuracy of the in-line system implemented at Children’s Healthcare of Atlanta at Egleston was assessed experimentally. The data assisted in the development of a novel automated and accurate fluid management system that functions based on a conservation of volume approach to limit the inaccuracies observed in typical clinical implementations of CVVH. IV pump accuracy measurements demonstrated a standard error in net ultrafiltrate volume removed from the patient of up to 848.5±156ml over a period of 24h, supporting previous observations of patient’s dehydration during the course of a combined ECMO-CVVH treatment and justifying the need for a new fluid management system. The innovative design of the new device is expected to achieve either a perfect or controlled negative fluid balance between the ultrafiltrate and replacement fluid flow rates. Perfect fluid balance is achieved by imposing an identical displacement on two pistons, one delivering replacement fluid to the circuit and the other draining ultrafiltrate from the hemofilter. Fluid removal is managed via a second syringe-pump system that reduces the net replacement fluid flow rate with respect to the ultrafiltration flow rate. The novel fluid management system described in this paper is expected to provide an effective method to control precisely fluid flow rates in patients on ECMO. Therefore, this device could potentially improve the efficacy of ECMO therapy and constitute a safe and effective way of reducing fluid overload in patients with cardiorespiratory failure.

Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure

2021 ◽  
pp. 1-8
Author(s):  
Jason M. Thomas ◽  
David N. Dado ◽  
Anthony P. Basel ◽  
James K. Aden ◽  
Sarah B. Thomas ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Fluid Management ◽  
Arterial Oxygen ◽  
Membrane Oxygenation ◽  
Negative Fluid Balance

<b><i>Introduction:</i></b> Fluid overload in extracorporeal membrane oxygenation (ECMO) patients has been associated with increased mortality. Patients receiving ECMO and continuous renal replacement therapy (CRRT) who achieve a negative fluid balance have improved survival. Limited data exist on the use of CRRT solely for fluid management in ECMO patients. <b><i>Methods:</i></b> We performed a single-center retrospective review of 19 adult ECMO patients without significant renal dysfunction who received CRRT for fluid management. These patients were compared to a cohort of propensity-matched controls. <b><i>Results:</i></b> After 72 h, the treatment group had a fluid balance of −3840 mL versus + 425 mL (<i>p</i> ≤ 0.05). This lower fluid balance correlated with survival to discharge (odds ratio 2.54, 95% confidence interval 1.10–5.87). Improvement in the ratio of arterial oxygen content to fraction of inspired oxygen was also significantly higher in the CRRT group (102.4 vs. 0.7, <i>p</i> ≤ 0.05). We did not observe any significant difference in renal outcomes. <b><i>Conclusions:</i></b> The use of CRRT for fluid management is effective and, when resulting in negative fluid balance, improves survival in adult ECMO patients without significant renal dysfunction.

Impact of bypass flow rate and catheter position in veno-venous extracorporeal membrane oxygenation on gas exchange in vivo

2014 ◽  
Vol 18 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Konomi Togo ◽  
Yoshiaki Takewa ◽  
Nobumasa Katagiri ◽  
Yutaka Fujii ◽  
Satoru Kishimoto ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Bypass Flow ◽  
Catheter Position ◽  
Membrane Oxygenation

Study on the effect of pore-scale heterogeneity and flow rate during repetitive two-phase fluid flow in microfluidic porous media

2021 ◽  
pp. petgeo2020-062
Author(s):  
Jingtao Zhang ◽  
Haipeng Zhang ◽  
Donghee Lee ◽  
Sangjin Ryu ◽  
Seunghee Kim
Keyword(s):  
Porous Media ◽  
Fluid Flow ◽  
Flow Rate ◽  
Sweep Efficiency ◽  
Residual Saturation ◽  
Flow Rates ◽  
Content Type ◽  
Lower Flow ◽  
Supplementary Material ◽  
Lower Flow Rate

Various energy recovery, storage, conversion, and environmental operations may involve repetitive fluid injection and, thus, cyclic drainage-imbibition processes. We conducted an experimental study for which polydimethylsiloxane (PDMS)-based micromodels were fabricated with three different levels of pore-space heterogeneity (coefficient of variation, where COV = 0, 0.25, and 0.5) to represent consolidated and/or partially consolidated sandstones. A total of ten injection-withdrawal cycles were applied to each micromodel at two different flow rates (0.01 and 0.1 mL/min). The experimental results were analyzed in terms of flow morphology, sweep efficiency, residual saturation, the connection of fluids, and the pressure gradient. The pattern of the invasion and displacement of nonwetting fluid converged more readily in the homogeneous model (COV = 0) as the repetitive drainage-imbibition process continued. The overall sweep efficiency converged between 0.4 and 0.6 at all tested flow rates, regardless of different flow rates and COV in this study. In contrast, the effective sweep efficiency was observed to increase with higher COV at the lower flow rate, while that trend became the opposite at the higher flow rate. Similarly, the residual saturation of the nonwetting fluid was largest at COV = 0 for the lower flow rate, but it was the opposite for the higher flow rate case. However, the Minkowski functionals for the boundary length and connectedness of the nonwetting fluid remained quite constant during repetitive fluid flow. Implications of the study results for porous media-compressed air energy storage (PM-CAES) are discussed as a complementary analysis at the end of this manuscript.Supplementary material: Figures S1 and S2 https://doi.org/10.6084/m9.figshare.c.5276814.Thematic collection: This article is part of the Energy Geoscience Series collection available at: https://www.lyellcollection.org/cc/energy-geoscience-series

scholarly journals Learning The Fluid/Flow Properties Using Microfluidics

2019 ◽  
Vol 215 ◽  
pp. 10002
Author(s):  
Pooria Hadikhani ◽  
Navid Borhani ◽  
S. Mohammad H. Hashemi ◽  
Demetri Psaltis
Keyword(s):  
Neural Networks ◽  
Fluid Flow ◽  
Microfluidic Device ◽  
Flow Rate ◽  
Deep Neural Networks ◽  
Good Accuracy ◽  
Flow Properties ◽  
Flow Rates

Deep neural networks (DNN) are employed to measure the flow rate and the concentration of the liquid using the images of the droplets in a microfluidic device. The trained networks are able to measure flow rates and concentrations with good accuracy.

The Effect of Decreasing Flow Rate on Cerebral Hemodynamics During Veno-Arterial Extracorporeal Membrane Oxygenation in Piglets

ASAIO Journal ◽  
2015 ◽  
Vol 61 (4) ◽  
pp. 448-452 ◽  
Author(s):  
Luella C. Gerrits ◽  
Arno F.J. van Heijst ◽  
Jeroen C.W. Hopman ◽  
Anton F.J. de Haan ◽  
Kian D. Liem
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Flow Rate ◽  
Cerebral Hemodynamics ◽  
Membrane Oxygenation

scholarly journals Four Layer Cylindrical Model of Mucus Transport in the Lung: Effect of Prolonged Cough

2019 ◽  
Vol 19 (1) ◽  
pp. 53-63
Author(s):  
Arti Saxena ◽  
Vijay Kumar ◽  
JB Shukla
Keyword(s):  
Fluid Flow ◽  
Flow Rate ◽  
Circular Tube ◽  
Medical Science ◽  
Moist Air ◽  
Serous Fluid ◽  
Mixture Flow ◽  
Flow Rates ◽  
Immotile Cilia ◽  
Laminar Condition

Background: In this paper, a four layer model of the simultaneous and coaxial flow of moist air, mucus, mixture of mucin and periciliary liquid and serous fluid (assumed to be incompressible and Newtonian fluids) in a circular tube under time dependent pressure gradient representing prolonged cough is analyzed to study the mucus transport in an airway in the presence of prolonged cough. It is assumed that air and mucus flow under quasi steady state turbulent conditions while the mixture of mucin and periciliary liquid and serous layer surrounding mixture layer flows under unsteady laminar condition in presence of immotile cilia carpet. Result: It is shown that the mucus transport increases as the viscosity of serous fluid decreases. Also the mixture and serous fluid flow rates increase as the viscosity of serous fluid decreases. It is also observed that the effect of resistance to flow by serous fluid in the cilia bed is to decrease flow rates. The flow rates of mucus and mixture of mucin and periciliary fluid increase as the viscosity of mixture decreases also air and mixture of mucus and periciliary fluid flow rates increase as the thickness of mixture increases. Conclusion: As the thickness of mucus increases its flow rate increases on the other hand the mixture flow rate, mucus and serous fluid flow rate decreases with the increase of the mixture thickness. Bangladesh Journal of Medical Science Vol.19(1) 2020 p.53-63

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