Skip to main content
SpringerLink
Log in

Postfiltration und Lungenperfusion

Einfache Modifikation der Herz-Lungen-Maschine

Postfiltration and lung perfusion

Simple modification of heart-lung machines

  • Kardiotechnik/EKZ
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Hämofiltration während herzchirurgischer Interventionen mit der Herz-Lungen-Maschine (HLM) ist eine gebräuchliche Methode, um einen Volumenüberschuss und inflammatorische Reaktionen des Körpers zu reduzieren bzw. Entgleisungen zu korrigieren. Je nach Größe der verwendeten Filtrationsmembran wird zwischen Mikro-, Ultra- oder Nanofiltration unterschieden. In der Kinderherzchirurgie sind sowohl die Ultrafiltration während der extrakorporalen Zirkulation (EKZ) als auch die Methode der modifizierten Ultrafiltration (MUF) nach Beenden der EKZ standardisierte Verfahren. In der Erwachsenherzchirurgie werden seit vielen Jahren die Vorteile der Hämofiltration genutzt. In der Abteilung für Thorax-, Herz-, und Thorakale Gefäßchirurgie des Universitätsklinikums Frankfurt werden Hämofilter im Bedarfsfall während Eingriffen mit der HLM oder nach Abgehen von der HLM als Postfiltration eingesetzt. Im vorliegenden Beitrag werden die Adaptationen der HLM beschrieben, die eine einfache und flexible Anwendung der Postfiltration über die liegenden Kanülen erlauben. Weiterhin wird das Set-up zur Lungenperfusion beschrieben.

Abstract

Hemofiltration is a useful method to reduce fluid overload and inflammatory response in patients undergoing open heart surgery with heart-lung machines (HLM). A differentiation is made between microfiltration, ultrafiltration and nanofiltration depending on the size of the filtration membrane used. In pediatric heart surgery the procedure of ultrafiltration during extracorporeal circulation (ECC) and the so-called modified ultrafiltration (MUF) following ECC are well established procedures after cardiopulmonary bypass (CPB) operations. The advantages of hemofiltration techniques during and after CPB in adults have been used for many years. In the department for thoracic and cardiac vascular surgery of the University Clinic in Frankfurt hemofilters are employed during interventions with a HLM or after disconnection from the HLM as postfiltration. In this article adaptations of the HLM which allow the simple and flexible application of postfiltration via an in-dwelling cannula and lung perfusion techniques are described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Beyersdorf F, Buckberg GD (1993) Myocardial protection in patients with acute myocardial infarction and cardiogenic shock. Semin Thorac Cardiovasc Surg 5:151–161

    CAS  PubMed  Google Scholar 

  2. Buckberg GD, Beyersdorf F, Allen BS, Robertson JM (1995) Integrated myocardial management: background and initial application. J Card Surg 10:68–89

    Article  CAS  PubMed  Google Scholar 

  3. Abdel-Rahman U, Aybek T, Moritz A et al (2003) Graded reoxygenation limits lipid peroxidation during surgical reperfusion. Med Sci Monit 9:CR389–CR391

    PubMed  Google Scholar 

  4. Zierer A, Detho F, Dzemali O et al (2011) Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg 91:1868–1873

    Article  PubMed  Google Scholar 

  5. Bakhtiary F, Dogan S, Zierer A et al (2008) Antegrade cerebral perfusion for acute type A aortic dissection in 120 consecutive patients. Ann Thorac Surg 85:465–469

    Article  PubMed  Google Scholar 

  6. Darup J, Bleese N, Kalmar P et al (1979) Hemofiltration during extracorporeal circulation (ECC). Thorac Cardiovasc Surg 27:227–230

    Article  CAS  PubMed  Google Scholar 

  7. Solem JO, Ståhl E, Kugelberg J, Steen S (1988) Hemoconcentration by ultrafiltration during open-heart surgery. Scand J Thorac Cardiovasc Surg 22:271–274

    Article  CAS  PubMed  Google Scholar 

  8. Nelgian P (oJ) What is the difference between dialysis and ultrafiltration? http://www.ccmtutorials.com/renal/rrt/page2.htm. Zugegriffen 14. Okt. 2013

  9. Berdat PA, Eichenberger E, Ebell J et al (2004) Elimination of proinflammatory cytokines in pediatric cardiac surgery: analysis of ultrafiltration method and filter type. J Thorac Cardiovasc Surg 127:1688–1696

    Article  CAS  PubMed  Google Scholar 

  10. Tassani P, Richter JA, Eising GP et al (1999) Influence of combined zero-balanced and modified ultrafiltration on the systemic inflammatory response during coronary artery bypass grafting. J Cardiothorac Vasc Anesth 13:285–291

    Article  CAS  PubMed  Google Scholar 

  11. Kamijo Y, Soma K, Sugimoto K et al (2000) The effect of a hemofilter during extracorporeal circulation on hemodynamics in patients with SIRS. Intensive Care Med 26:1355–1359

    Article  CAS  PubMed  Google Scholar 

  12. Warren OJ, Smith AJ, Alexiou C et al (2009) The inflammatory response to cardiopulmonary bypass: part 1 – mechanisms of pathogenesis. J Cardiothorac Vasc Anesth 23:223–231

    Article  PubMed  Google Scholar 

  13. Torina AG, Silveira-Filho LM, Vilarinho KA et al (2012) Use of modified ultrafiltration in adults undergoing coronary artery bypass grafting is associated with inflammatory modulation and less postoperative blood loss: a randomized and controlled study. J Thorac Cardiovasc Surg 144:663–670

    Article  PubMed  Google Scholar 

  14. Herbst-Rodrigues MV, Carvalho VO, Auler JO, Feltrim MI (2011) PEEP-ZEEP technique: cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery. J Cardiothorac Surg 6:108

    Article  PubMed Central  PubMed  Google Scholar 

  15. Schlensak C, Beyersdorf F (2005) Lung injury during CPB: pathomechanisms and clinical relevance. Interact Cardiovasc Thorac Surg 4:381–382

    Article  PubMed  Google Scholar 

  16. Gabriel EA, Locali RF, Matsuoka PK et al (2008) Lung perfusion during cardiac surgery with cardiopulmonary bypass: is it necessary? Interact Cardiovasc Thorac Surg 7:1089–1095

    Article  PubMed  Google Scholar 

  17. Sievers H-H, Freund-Kaas C, Eleftheriadis S et al (2002) Lung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy. Ann Thorac Surg 74:1167–1172

    Article  PubMed  Google Scholar 

  18. Apostolakis EE, Koletsis EN, Baikoussis NG et al (2010) Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. J Cardiothorac Surg 5:1

    Article  PubMed Central  PubMed  Google Scholar 

  19. Siepe M, Goebel U, Mecklenburg A et al (2008) Pulsatile pulmonary perfusion during cardiopulmonary bypass reduces the pulmonary inflammatory response. Ann Thorac Surg 86:115–122

    Article  PubMed  Google Scholar 

  20. Liu L, Hu J, Yin B et al (2005) Lung protection of continuous pulmonary artery perfusion with oxygenated blood during cardiopulmonary bypass. Zhong Nan Da Xue Xue Bao Yi Xue Ban 30:413–416

    CAS  PubMed  Google Scholar 

  21. Zhang R, Wang Z, Wang H et al (2010) Optimal pulmonary artery perfusion mode and perfusion pressure during cardiopulmonary bypass. J Cardiovasc Surg (Torino) 51:435–442

    Google Scholar 

  22. Papadopoulos N, Bakhtiary F, Grün V et al (2013) The effect of normovolemic modified ultrafiltration on inflammatory mediators, endotoxins, terminal complement complexes and clinical outcome in high-risk cardiac surgery patients. Perfusion 28:306–314

    Article  CAS  PubMed  Google Scholar 

  23. Weber CF, Jámbor C, Strasser C et al (2011) Normovolemic modified ultrafiltration is associated with better preserved platelet function and less postoperative blood loss in patients undergoing complex cardiac surgery: a randomized and controlled study. J Thorac Cardiovasc Surg 141:1298–1304

    Article  PubMed  Google Scholar 

  24. Skaryak LA, Kirshbom PM, DiBernardo LR et al (1995) Modified ultrafiltration improves cerebral metabolic recovery after circulatory arrest. J Thorac Cardiovasc Surg 109:744–751

    Article  CAS  PubMed  Google Scholar 

  25. Wang S, Palanzo D, Ündar A (2012) Current ultrafiltration techniques before, during and after pediatric cardiopulmonary bypass procedures. Perfusion 27:438–446

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. Der korrespondierende Autor weist auf folgende Beziehung hin: H. Keller ist leitender Kardiotechniker bei Maquet Clinical Services für das Universitätsklinikum Frankfurt a. M. A. Moritz: Es besteht kein Interessenkonflikt. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt a. M., Deutschland

    H. Keller & A. Moritz

Authors
  1. H. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Moritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Keller.

Additional information

Die verwendeten Produkte (Hämokonzentrator, Kanülen etc.) entsprechen dem derzeitigen Standard der THG des Universitätsklinikums Frankfurt. Die Durchführung der Postfiltration und Lungenperfusion ist nicht an die im Text erwähnten Produkte gebunden. Es können natürlich die in den jeweiligen Kliniken in der Routine bewährten Produktalternativen anderer Hersteller verwendet werden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keller, H., Moritz, A. Postfiltration und Lungenperfusion. Z Herz- Thorax- Gefäßchir 28, 133–140 (2014). https://doi.org/10.1007/s00398-013-1035-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-013-1035-x

Schlüsselwörter

Keywords

Search

Navigation