Insensible Water Loss Through Adult Extracorporeal Membrane Oxygenation Circuit

Li, Chang Li; Yan, Tam Oi; Arthur, Kwan Ming Chit; Shum, Hoi‐Ping; Kenny, Chan King Chung; Wa, Yan Wing

doi:10.1097/mat.0000000000000098

Cited by 8 publications

(9 citation statements)

References 8 publications

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“…Similarly, our data demonstrated a significant but weak correlation between ECMO blood flow rate and calculated water loss, with two groupings of data points scattered across varying levels of flow. These findings are congruent with previous studies demonstrating that ECMO flow was not an important factor associated with the degree of water loss from the ECMO circuit ( 8 – 12 ).…”

Section: Discussionsupporting

confidence: 92%

“…Our in vivo findings are consistent with previous in vitro studies demonstrating that sweep gas was the major driver of water loss in ECMO circuits ( 8 – 12 ). Measured insensible water loss via various oxygenators in these studies ranged from 48 ml/day per L/min of sweep to 83 ml/day per L/min of sweep; our study demonstrated oxygenator-associated water loss that is at the upper end of this range ( 8 – 12 ). Camacho et al studied the Avecor oxygenator and designed a study to compare oxygenator size, blood flow rates, and sweep in relation to insensible water loss.…”

Section: Discussionsupporting

confidence: 92%

“…Unexpectedly, the correlations of water loss to both temperature and blood flow were statistically significant but had a low coefficient of determination, indicating a significant finding, but a small contribution by either temperature or blood flow. One previous study had suggested an association between the temperature of the fluid and the water loss ( 12 ). Our results showed a trend in the opposite direction: as the temperature of the fluid increased the trend line was weakly negative.…”

Section: Discussionmentioning

confidence: 99%

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In vivo measurement of pediatric extracorporeal oxygenator insensible losses; a single center pilot study

Suttles,

Poe,

Neumayr

et al. 2024

Front. Pediatr.

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IntroductionFluid overload on Extracorporeal Membrane Oxygenation (ECMO) is associated with worse outcomes. Previous in vitro studies have attempted to quantify oxygenator-related insensible losses, as failure to account for this fluid loss may lead to inaccurate fluid balance assessment and potentially harmful clinical management, such as unnecessary exposure to diuretics, slow continuous ultrafiltration (SCUF), or continuous kidney replacement therapy (CKRT). We performed a novel in vivo study to measure insensible fluid losses in pediatric ECMO patients.MethodsPediatric ECMO patients were approached over eleven months in the pediatric and cardiac intensive care units. The water content of the oxygenator inflow sweep gas and exhaust gas were calculated by measuring the ambient temperature and relative humidity at frequent intervals and various sweep flow.Results and discussionNine subjects were enrolled, generating 431 data points. The cohort had a median age of 11 years IQR [0.83, 13], weight of 23.2 kg IQR [6.48, 44.28], and body surface area of 0.815 m2 IQR [0.315, 1.3725]. Overall, the cohort had a median sweep of 2.5 L/min [0.9, 4], ECMO flow of 3.975 L/m2/min [0.75, 4.51], and a set ECMO temperature of 37 degrees Celsius [36.6, 37.2]. The calculated net water loss per L/min of sweep was 75.93 ml/day, regardless of oxygenator size or patient weight. There was a significant difference in median documented vs. calculated fluid balance incorporating the insensible fluid loss, irrespective of oxygenator size (pediatric oxygenator: 7.001 ml/kg/day [−12.37, 28.59] vs. −6.11 ml/kg/day [−17.44, 13.01], respectively, p = 0.005 and adult oxygenator: 14.36 ml/kg/day [1.54, 25.77] and 9.204 ml/kg/day [−1.28, 22.05], respectively, p = <0.001). We present this pilot study of measured oxygenator-associated insensible fluid losses on ECMO. Our results are consistent with prior in vitro methods and provide the basis for future studies evaluating the impact of incorporating these fluid losses into patients' daily fluid balance on patient management and outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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In vivo measurement of pediatric extracorporeal oxygenator insensible losses; a single center pilot study

Suttles,

Poe,

Neumayr

et al. 2024

Front. Pediatr.

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“…Diuretics in addition to age-related physiologic changes such as decreased thirst drive can lead to reduced net body water ( 37 ). Furthermore, studies in critical ill patients showed high rates of dehydration caused by insensible water loss due to increased respiratory rate ( 38 ). Among all subgroups in our cohort, hypernatremic patients in COVID-19 and controls had the highest respiratory rates, which may have contributed to hypernatremia.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls

Atila

Sailer

Bassetti

et al. 2021

European Journal of Endocrinology

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Objective: The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. Design: The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. Methods: Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. Results: 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs. 17.5%, p<0.001); while comparable for hypernatremia (2.9% vs 2.1%, p=0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR 1.4, 95%-CI 1.10-16.62, p=0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19: HR 11.5, 95%-CI 5.00-26.43, p<0.001; controls: HR 5.3, 95%-CI 1.60-17.64, p=0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, e.g. intensive care unit admission, longer hospitalization, and mechanical ventilation. Conclusion: Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware and appropriate treatment measures taken in patients with COVID-19 and dysnatremia.

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“…Since fluid and electrolyte balance are a primary concern and particularly challenging for neonatal and pediatric population, 15 almost all tests were run at flow rates that could approximate clinical parameters seen in infants ECMO; only Li Li et al 34 performed a study to assess the adult ECMO fluid loss. Nearly, all tests were run over at least 24 hours to obtain practical results for a clinical fluid balance assessment.…”

Section: Oxygenator Performancementioning

confidence: 99%

Ex vivo models for research in extracorporeal membrane oxygenation: a systematic review of the literature

Malfertheiner

Broman

Vercaemst³

et al. 2020

Perfusion

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With ongoing progress of components of extracorporeal membrane oxygenation including improvements of oxygenators, pumps, and coating materials, extracorporeal membrane oxygenation became increasingly accepted in the clinical practice. A suitable testing in an adequate setup is essential for the development of new technical aspects. Relevant tests can be conducted in ex vivo models specifically designed to test certain aspects. Different setups have been used in the past for specific research questions. We conducted a systematic literature review of ex vivo models of extracorporeal membrane oxygenation components. MEDLINE and Embase were searched between January 1996 and October 2017. The inclusion criteria were ex vivo models including features of extracorporeal membrane oxygenation technology. The exclusion criteria were clinical studies, abstracts, studies in which the model of extracorporeal membrane oxygenation has been reported previously, and studies not reporting on extracorporeal membrane oxygenation components. A total of 50 studies reporting on different ex vivo extracorporeal membrane oxygenation models have been identified from the literature search. Models have been grouped according to the specific research question they were designed to test for. The groups are focused on oxygenator performance, pump performance, hemostasis, and pharmacokinetics. Pre-clinical testing including use of ex vivo models is an important step in the development and improvement of extracorporeal membrane oxygenation components and materials. Furthermore, ex vivo models offer valuable insights for clinicians to better understand the consequences of choice of components, setup, and management of an extracorporeal membrane oxygenation circuit in any given condition. There is a need to standardize the reporting of pre-clinical studies in this area and to develop best practice in their design.

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Insensible Water Loss Through Adult Extracorporeal Membrane Oxygenation Circuit

Cited by 8 publications

References 8 publications

In vivo measurement of pediatric extracorporeal oxygenator insensible losses; a single center pilot study

In vivo measurement of pediatric extracorporeal oxygenator insensible losses; a single center pilot study

Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls

Ex vivo models for research in extracorporeal membrane oxygenation: a systematic review of the literature

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