Hyperthermic regional perfusion using membrane- instead of bubble-oxygenators. An experimental and clinical study.
To achieve adequate tissue perfusion during hyperthermic regional perfusion, perfusion pressures should be maintained at near normal mean systemic arterial pressures. During experimental as well as during clinical perfusions however, unphysiologically high perfusion flows were needed to keep the perfusion pressure at the desired level. Since both high perfusion flows and high perfusion pressures have been associated with the post-operative complications such as severe edema and tissue damage, as well as with an increased leakage of perfusate to the systemic circulation, low perfusion flows have been used in regional perfusion. High perfusion flows in our previous experimental studies were attributable to a marked reduction in vascular resistance. This decrease is believed to be caused by the release of vasodilatory constituents of damaged blood cells, and it is the extra-corporeal circuit, and in particular the bubble-oxygenator that is thought to be responsible. The superior haemocompatibility of membrane-oxygenators over bubble-oxygenators has been established in cardio-pulmonary bypass. We compared the use of a membrane-oxygenator with that of a bubble-oxygenator in regional perfusion to see if more normal haemodynamics could be maintained and vasodilatation prevented. In the experimental as well as in the clinical perfusions the use of a bubble-oxygenator required unphysiologically high perfusion flows to maintain the perfusion pressure at the level required to obtain an adequate microcirculation. In contrast the use of a membrane-oxygenator permitted a nearly physiological perfusion flow to maintain an adequate perfusion pressure as well as an adequate micro-circulation.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Surgical Oncology, University Hospital, Groningen, The Netherlands.
J
J
van Os
H
H
Schraffordt Koops
J
J
Oldhoff
C R
CR
Wildevuur
D000818:Animals; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D004285:Dogs; D006439:Hemodynamics; D006614:Hindlimb / Q000098:blood supply; D006801:Humans; D006979:Hyperthermia, Induced; D007866:Leg / Q000098:blood supply; D008545:Melanoma / Q000188:drug therapy*; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use*; D008833:Microcirculation; D010106:Oxygenators; D010107:Oxygenators, Membrane; D011312:Pressure; D014664:Vasodilation
D008558:Melphalan