Insensible water loss from the Jostra Quadrox D oxygenator: an in vitro study

Abstract

Extracorporeal membrane oxygenation (ECMO) has been shown to improve outcomes in neonatal patients with respiratory and/or cardiac failure. Insensible water loss is defined as water loss via evaporation from the skin and respiration. Fluid and electrolyte balance are a primary concern and very challenging in the neonatal patient population. Hypernatremia can result from untreated insensible water loss, leading to possible cerebral complications. A new type of fiber used in the Jostra Quadrox D oxygenator has recently been approved for use in the United States of America. This oxygenator uses a polymethylpentene closed hollow-fiber technology and has been approved for six hours of continuous use by the Federal Drug Administration. The closed hollow-fiber technology may be advantageous for extended use due to the fact that it is a true membrane and plasma leakage will not occur across its surface. The Jostra Quadrox D is an adult-sized oxygenator with a surface area of 1.8 M(2). The aim of this study is to discover what the insensible water loss will be from the Jostra Quadrox D when used at blood flows which would mimic those used for a neonatal ECMO patient. The median insensible water loss from the Quadrox D oxygenator at a gas flow rate of two liters per minute(LPM) was 4.0 +/- 0.2 ml/hour, at five LPM was 9.8 +/- 0.4 ml/hour and at 10 LPM was 20.6 +/- 0.7 ml/hour. The daily evaporative water loss from the Jostra Quadrox D can be estimated to be 48.0 +/- 2.1 ml for each LPM of sweep gas with a normal saline pump flow rate of 500 ml/min.

Insensible water loss from the Hilite 2400LT oxygenator: an in vitro study

“…Where a disconnect between the observation of a problem’s occurrence and the response to that particular problem may occur is if the problem is not expected or the clinician cannot highlight the cause. Water loss from an ECMO oxygenator, although previously described, 4-6 remains a potentially unexpected cause of hypernatraemia in the ECMO/ICU patient. As discussed earlier, the neonatal population is very susceptible to an uncompensated free water loss due to their proportionally small circulating volume in comparison to the amount of water lost over a 24-hour period.…”

“…The daily loss we recorded, using the Hilite ® 2400LT PMP membrane, was 72.4 ml/day per L/min/gas flow. Camacho et al 4 recorded 72ml/day per L/min/gas flow, utilising a silicone membrane, Alexander et al 5 reported 83 ml/day with a microporous, hollow-fibre membrane, and Lawson and Holt 6 measured 48 ml/day with the PMP membrane within the Quadrox D.…”

“…Of particular interest, due to the membrane material under investigation, was a study by Lawson and Holt. 6 Investigating the polymethylpentene (PMP) membrane within the Quadrox D oxygenator (Maquet Cardiopulmonary AG, Hirrlingen, Germany), they described a 48-ml water loss per day, per L/min gas flow.…”

A biohybrid artificial lung prototype with active mixing of endothelialized microporous hollow fibers

“…Six MHF patches were affixed with polycin/vorite glue (60% Polycin, 40% Vorite by mass, Cas Chem) in a 50 mL conical tube. PMP MHFs were chosen due to an asymmetric geometry, which is attractive for its resistance to plasma weeping and would theoretically not experience increased plasma weeping if made hydrophilic by surface modification to support cell adhesion (Khoshbin et al, 2005;Lawson and Holt, 2007;Toomasian et al, 2005). Select groups of fiber patches were exposed to radio frequency glow discharge (RFGD; March Plasma Systems, Concord, CA) treatment while in the conical tube (0.3 Torr vacuum and ammonia gas for 60 s at 100 W).…”

Extracorporeal life support systems: alternative vs. conventional circuits

“…5 However, it requires an extrinsic heat exchanger, which significantly increases the priming volume of the circuit. While hollow-fiber membrane oxygenators have had complications with plasma leakage, 6 the newer Quadrox-iD Pediatric oxygenator (Maquet, Inc. Wayne, NJ, USA), recently approved by the FDA, utilizes tight hollow-fiber membranes made of polymethylpentene to eliminate plasma leakage as well as the formation of micro-bubbles. It has advantages of high gas exchange and biocompatible coating, which reduces clotting activity, thrombus formation, and complement activation [7][8][9] .…”