Exposure of patients to di(2-ethylhexy)phthalate (DEHP) and its metabolite MEHP during extracorporeal membrane oxygenation (ECMO) therapy

Abstract

The plasticizer di(2-ethylhexyl)phthalate (DEHP) is often used for PVC medical devices, that are also largely used for intensive care medical treatments, like extracorporeal membrane oxygenation (ECMO) therapy. Due to the toxicological potential of DEHP, the inner exposure of patients with this plasticizer is a strong matter of concern as many studies have shown a high leaching potential of DEHP into blood. In this study, the inner DEHP exposure of patients undergoing ECMO treatment was investigated. The determined DEHP blood levels of ECMO patients and the patients of the control group ranged from 31.5 to 1009 μg/L (median 156.0 μg/L) and from 19.4 to 75.3 μg/L (median 36.4 μg/L), respectively. MEHP blood levels were determined to range from < LOD to 475 μg/L (median 15.9 μg/L) in ECMO patients and from < LOD to 9.9 μg/L (median 3.7 μg/L) in the control group patients, respectively. Increased DEHP exposure was associated with the number of cannulas and membranes of the ECMO setting, whereas residual diuresis decreased the exposure. Due to the suspected toxicological potential of DEHP, its use in medical devices should be further investigated, in particular for ICU patients with long-term exposure to PVC, like in ECMO therapy.

Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma in patients aged 60 and older: a retrospective cohort study

“…Second, a substantial proportion of patients lacked sufficient c-reactive protein (CRP) levels; thus, CRP/Alb ratios could not be calculated [24][25][26]. The total bilirubin level (TBIL) is a significant index of liver function [27][28][29][30], and thus, TBIL was monitored and high TBIL was promptly treated. Additionally, TBIL was an important independent prognosis predictor for ICC patients [31][32][33] and was significantly higher in the OH than LH group on the first postoperative blood tests (Table 3).…”

Tissue-specific metabolomic profiling after cardiopulmonary bypass in fetal sheep

“…DEHP has been reported to increase significantly in neonates receiving cardiac surgery ( 36 ). MEHP, a common metabolite of DEHP in vivo , was also found to accumulate in the blood and urine after CPB ( 30 ). In the present study, we observed increased levels of MEHP in the bypass group in the liver (136.7-fold of the control group, P = 0.00003) and brain (13.3-fold of the control group, P = 0.0007).…”

Medical devices as a source of phthalate exposure: a review of current knowledge and alternative solutions

“…Blood is in contact with PVC lines with high flow rate (5 to 6 L/min) and mechanical strain at 37 °C for longer periods of time, which all are conditions favouring plasticiser migration ( 102 ). One study ( 103 ) showed considerable amounts of DEHP and its metabolite MEHP in a patient on ECMO. Their levels seem to correlate with runtime and amount of cannulas and membranes used during treatment.…”