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oxygenators.ppt
- 1. Choice of Oxygenatorsand Patient Outcome Jinil Raj T S Fortis Hospital Mumbai
- 2. Membrane lung VSNatural lung
- 3. What harm anOxygenator does? • Hemodilution and allogenic transfusion • Trauma to blood cells • SIRS • GME
- 4. An Ideal Oxygenator •Less priming volume. • As Bio compactable as possible. • Maximum rated flow • Minimum blood contact area. • Minimal pressure drop so that the trauma. • Effective in managing GME.
- 5. “Not only themembrane matters”
- 6. Semi Adult • SorinInspire 6F • Maquet Quadrox 50000 • Terumo RX15
- 7. Adult • Inspire adult8F • Maquet Quadrox 70000 • Terumo RX 25 • Medtronic fusion • Medos Hilite 7000
- 8. Priming Volume • Alsocalled Static Priming Volume • Forever Lost to circulation • Important factor – Hemodilution The Lesser, The Better….
- 9. Dynamic Priming Volume •Oxygenator priming volume • Minimum operating level • Hold up volume at maximum rated flow • Venous downtube collector volume
- 10. Dynamic Priming Volume Oxymodule priming Volume Minimum Operating Level Venous filter hold- up Volume Venous collector Priming Volume
- 11. Comparison of StaticPriming volume Semi Adult
- 12. Adult 0 50 100 150 200 250 300 350 400 medtronicfusion terumo capioxFX25maquetquadrox 50000 sorin inspire 8F 260 ml 260 ml 335 ml 351 ml
- 13. Membrane Surface Area •Signifies area available for gas exchange • Area of contact of blood with oxygenating surface • Gas Exchange – Diffusion • Aggregation of formed elements • Potential source of SIRS • Physiological Coating in most Oxygenators
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- 15. Adult 0 0.5 1 1.5 2 2.5 3 medtronicfusion terumocapiox FX25maquet quadrox 70000 sorininspire 8F 2.5 M 2.5M 1.8M 1.75M
- 16. Rated flow Max (rated)blood flow - upper limit of blood flow through Oxygenator. that can safely conduct the process of gas transfer ensuring SO2 > 95% at standard Venous inlet conditions (with SO2 of 65 ± 5 % at the inlet of Oxygenator with Hb of 12 ± 1% at 37 ± 2deg C,base excess of 0 ± 5 mEq/L and a pCO2 of 45 ± 5 mmHg)
- 17. Reference Blood flow Maxpossible flow ensuring PO2 > 100 mmHg and PCO2 of 35mmHg under AAMI test standards (Hb: 12g/dl, Temp 37DegC,FiO2 100%, SvO2 65%, Venous PCO2 45mmHg)
- 18. Rated or reference???? •Rated Flow – Performance in Clinically recommended safe limits • Reference Flow – Performance in Ideal Environment. Reference flow – OFF LABEL USE (Not Recommended Clinically) Raised GME, Membrane Rupture,etc
- 19. Semi Adult 4.4 4.6 4.8 5 5.2 5.4 5.6 5.8 6 6.2 terumocapiox FX15maquet quadrox50000 sorininspire 6F 5 Ltr. 5 Ltr. 6 Ltr.
- 20. Adult 6.4 6.6 6.8 7 7.2 7.4 7.6 7.8 8 8.2 medtronicfusion terumocapiox FX25maquet quadrox 70000 sorininspire 8F 7 Ltr. 7 lLtr. 7 Ltr. 8 Ltr.
- 21. Oxygen Transfer • Definedas Amount of Oxygen (ml) transferred per minute at AAMI reference standards (Hb: 12g/dl, Temp 37DegC,FiO2 100%, SvO2 65%, Venous PCO2 45mmHg) • Factor of Oxygenator Efficiency
- 22. Semi Adult 0 50 100 150 200 250 300 350 400 terumocapiox FX15maquetquadrox50000 sorininspire6F 290 ml 360 ml 325 ml
- 23. Adult 0 100 200 300 400 500 600 medtronicfusion terumocapiox FX25 maquet quadrox 70000 sorininspire8F 400 ml 500 ml 430 ml 475 ml
- 24. CO2 transfer • Definedas the amount of CO2 (ml) transferred per minute of flow under AAMI reference standards (Hb: 12g/dl, Temp 37DegC,FiO2 100%, SvO2 65%, Venous PCO2 45mmHg) • Another marker of Oxygenator efficiency
- 25. Semi Adult 0 50 100 150 200 250 300 350 terumocapiox FX15maquet quadrox50000 sorininspire 6F 250 ml 240 ml 310 ml
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- 27. Pressure Drop Difference inpressure between the oxygenator inlet and oxygenator outlet as per AAMI reference standards (Hb: 12g/dl, Temp 37DegC,FiO2 100%, SvO2 65%, Venous PCO2 45mmHg) Oxygenator inlet - Highest pressurized area the circuit Important • Trauma to formed elements, • Resistance to blood flow, • Formed element aggregation,etc
- 28. Important in neonates… •Higher flows • Longer CPB run • Lower pressure drop - Lower Leukocyte activation The lesser … the better….
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- 31. Heat Exchanger Performance Twofactors considered Heat Exchanger Surface Area Heat Exchanger Efficiency Tested as per AAMI reference standards (Heat Exchanger Inlet Temp = 30 Deg C Outlet Temp = 40DegC Water Flow = 10 to 15L per minute ,Hb = 12 g/dl ) • More Area – Better efficiency ???
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- 34. GME production • CPB- post op neurological sequelae • Obstructive to microcirculation • Destructive to capillary endothelium • Micro emboli escapes the filters(< 40 microns) • Smaller number ,smaller size- Normothermia • Greater number and size- Hypothermic conditions • Open purge line- lesser micro emboli
- 35. Capillaries - 4µm to 9 µm Arterioles – 10 µm to 50 µm Metarterioles – 8 µm to 30 µm Gaseous micro emboli are commonly indicated as potential sources of neurological damage after CPB. Brown WR et al: Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral micro emboli. Stroke 2000; 31; 707-13
- 36. Smaller micron sizesin Venous filters reduces the amount & size of GME RESERVOIR FILTER SIZE KIDS 100 51 MICRONS QUADROX NEONATAL 64 MICRONS BABY RX 47 MICRONS DIDECO 901 NA MEDOS HILITE 1000 NA
- 37. • At 400ml/min – Most GME eliminated • At 700ml/min- RX 05 – Least no of GME • RX 05 – least amount of GME to reach patient
- 38. Surface Coating Oxygenator Coating MaquetBioline Terumo X coating Sorin Physio Medtronic Balance biosurface Medos Rheoparin
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- 40. Bioline Coating • Albumin+ Heparin
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- 43. An Ideal oxygenator •Tepered reservoir • Preconnected recirculation lines • Orientation of holder • Rotatable oxygenator and suction ports. • Ideal sizing of manifold purge line.
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- 46. Rotatable Oxygenator andsuction ports Reduce the tubing length thus the contact surface area
- 47. Ideal sizing ofmanifold purge line. • Redirected flow or “Stolen” blood flow Hypo perfusion 400 ml/min - 110 ml/min-stolen-27%
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- 50. To conclude... “An idealoxygenator is like an ideal spouse” Cannot have all qualities together