JP2019177293A - 低圧酸素化を用いた心肺バイパスのためのシステムおよび方法 - Google Patents
低圧酸素化を用いた心肺バイパスのためのシステムおよび方法 Download PDFInfo
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Abstract
Description
低圧酸素化は、窒素を用いることなく、所望の血液ガスを得るために、人工肺のガス対血液O2の拡散勾配を制御する。結果として生じた溶解した血液ガスの減少は、GMEの水溶性の再吸収(aqueous reabsorption)を支持し、CPB回路の全体にわたって観察されるGMEの除去の向上をもたらす。GMEに対して観察された効果の大きさは、不飽和水溶液中における空気微粒子の公開されている動力学と一致していると思われる。注目すべきことに、血液ガスの不飽和は脱窒素のみよりも重要である。インビトロのデータは、脱窒素された基準気圧の酸素制御条件と、脱窒素された低圧酸素化条件または不飽和状態の低圧酸素化条件との間に差異を示す。人工肺の中空糸内における大気中より低い圧力の付加的な物理効果は、より遠位部位におけるGME除去ではなく、人工肺のGME除去に寄与し得る。
図1A〜図1Dはインビトロの低圧酸素化に関する。図1Aは低圧酸素化装置(hypobaric oxygenation apparatus)を表している。密封されたハウジングを有する標準的な中空糸微孔性膜型人工肺(hollow fiber microporous membrane oxygenator)のスイープガス入口には純酸素が供給される。これに代わって、人工肺は微小孔を含まなくてもよい。人工肺のハウジングは、通気口をエポキシパテで物理的に閉塞することを含む、市販の人工肺ハウジングの通気口を物理的に閉塞することにより密閉され得る。同様に、密封された人工肺用ハウジングを得るために、いかなる適当な方法を用いてもよい。スイープガス出口にある調節された真空供給源は、血液の酸素化のために分圧勾配を調節するために、使用者により決定される圧力であって変更可能な大気圧より低い圧力をスイープガス隔室に印加する。真空計は適用される圧力を測定し、一方、正圧リリーフ弁(PPR)は正圧の生成を防止する。スイープガス入口にある流量計、例えばニードル弁流量計は、周囲圧から大気圧より低い圧力への圧力降下を可能にするとともに、スイープガス流量を調節し、よってCO2除去を調節する。
図4Aは、厚さ4μmのヘマトキシリン・エオシン染色した脳室周囲白質の切片の10倍(10X)の顕微鏡写真を示す。拡張した毛細血管は、内皮細胞の単一層によって取り囲まれた空隙(白)として見える。スケールバー=100μm。
次に、低圧酸素化がCPB回路におけるGMEの除去を改善するかについて試験した。まず、人工肺の上流にGMEボーラスを注入した(図2A)。人工肺が周囲圧力で100%酸素スイープガスを用いた場合には、強い下流ドップラー信号が観察された(図2B)。スイープガス圧力を0.9ataにわずかに低下させると、ドップラー信号は対照から94.8±1.0%低下し(曲線下面積、範囲90.9〜98.3%、n=9回試験、p<0.001)、一方、0.8ataでは、前記信号は辛うじて識別可能であった(対照から99.6±0.07%低下、範囲99.3〜99.8%、n=10回試験、p<0.001)。次に、空気混入は大きな進行中の塞栓の送入を模擬した。スイープガス圧力を低下させることにより、再び、動脈フィルタの前で測定したドップラー信号の大幅な用量依存的低下が生じた(図2C、スイープガス圧力が0.9ataであった場合には26±3%低下、0.8ataでは66±2%、0.7ataでは83±2%、0.6ataでは91±0.2%、0.5ataでは95±2%、0.4ataでは98±1%低下、スピアマンの順位相関係数ρ=1.0、n=3回連続試験)。ドップラーを動脈フィルタの下流に移動した場合には、実質的な塞栓信号は、動脈ろ過(前置ろ過器ベースライン信号、図2Dの81±3%)を使用したにもかかわらず、基準気圧条件下で存続した。下流信号は、スイープガス圧力の低減によって、さらに効率的に低下した(0.9ataではフィルタ後のベースラインの53±4%、0.8ataでは83±2%、0.7ataでは94±1%、0.6ataでは99±0.3%、0.5ataでは99.5±0.1%、および0.4ataでは99.7±0.1%低下、ρ=1.0、n=3回連続試験)。全体として、これらのデータは、低圧酸素化の使用により、CPB回路の循環血からGMEを除去する能力が用量依存的に高められることを示している。
連続した空気混入の間に、単一部位の半定量的ドップラーおよび多部位の定量的EDACは、CPB回路(図3A)内のGMEを検知した。データは、総数N=8頭のブタにおいて、CPBパラメータの変化によって分けられたれた個々の試験(n)において収集された。低圧酸素化は、大動脈カニューレ付近におけるドップラー信号を、対照(n=7、N=3)と比較して、99.1±0.3%(範囲95.8〜100%、n=16回試験、N=7頭のブタ)低下させた。低圧(N=5頭のブタ)条件および対照(N=3)条件からのEDACデータを図3Bに示す。人工肺の近位側では、EDACのGME計数および体積は、低圧(n=10回試験およびp>0.29)と対照(n=7)とでは同様であった。人工肺より下流では、低圧条件のGME数は、対照と比較して、大幅に低減され、人工肺後の位置では68.4±14.1%(範囲13.1〜91.3%、n=5、p<0.05)、動脈フィルタ後の位置では92.6±4.2%(範囲57.8〜99.8%、n=10、p<0.01)、患者に進入する位置では99.96±0.02%(範囲99.87〜99.99%、n=5、p<0.001)低減された。GME体積もまた、人工肺後の位置では80.5±5.6%(62.2〜95.6%、n=5、p<0.05)、フィルタ後の位置では94.9±2.9%(範囲74.3〜99.8%、n=10、p<0.01)、患者に進入する位置では99.97±0.01%(範囲99.94〜100%、n=5、p<0.001)減少した。対照試験は、これらの各位置において、n=3、7、および4であった。これらのデータは、低圧酸素化がインビボにおけるCPB回路からのGMEの除去を強力に高めることを示している。さらに、前記データは、GMEの除去が高められた部位が、血液が患者に向かって流れるにつれ、人工肺から動脈フィルタ、そして血液自体へと漸進的に広がっていることを示している。重要なことには、患者に最も接近して取得されたデータは、上流における塞栓の送入量が大きいにもかかわらず、動脈ろ過および低圧酸素化の併用によりCPB回路からのGMEの送達のほぼ完全な排除を示している。
図5A〜図5Dは、低圧酸素化によって管理された動物からの末梢血、脳および腎臓の顕微鏡による評価を示す(スケールバー=100μm)。具体的には、これらの図は正常な細胞構造を示した。
Claims (10)
- 心肺バイパスのためのシステムであって、
酸素圧力を調節するように構成された圧力調整器を備えた酸素供給源と、
スイープガス入口を介して前記酸素供給源の前記圧力調整器に流体接続された人工肺であって、前記スイープガス入口は大気圧より低い圧力を有するように構成され、前記人工肺は血液を酸素化するように構成されている、前記人工肺と、
スイープガス出口を介して前記人工肺に流体接続され、前記大気圧より低い圧力を提供するように構成された真空調圧器と、
前記スイープガス入口に流体接続され、前記酸素供給源から前記人工肺への圧力降下を可能にするように構成された流量制限器と、
を備える、システム。 - 前記酸素供給源を受容するように構成された流量制御装置をさらに備える、請求項1に記載のシステム。
- 前記流量制御装置と流体連通した気化器をさらに備える、請求項2に記載のシステム。
- 前記気化器は大気圧で動作するように構成されている、請求項3に記載のシステム。
- 該システムは、
心肺バイパス貯留槽と、
該システムに圧力を提供するように構成され、前記心肺バイパス貯留槽と流体連通したポンプと、
前記人工肺の血液出口に流体接続され、血液をろ過するように構成された動脈フィルタと、
前記動脈フィルタと前記心肺バイパス貯留槽とに流体接続された患者インターフェースと、をさらに備える、請求項1〜請求項4のいずれか1項に記載のシステム。 - 前記動脈フィルタはパージラインを介して前記心肺バイパス貯留槽に流体接続される、請求項5に記載のシステム。
- 前記人工肺の血液入口と流体連通した第1EDACサイトと、動脈フィルタ出口と流体連通した第2EDACサイトと、患者インターフェース入口と流体連通した第3EDACサイトとをさらに含む、請求項5または請求項6に記載のシステム。
- 前記スイープガス出口に流体接続された正圧リリーフ弁をさらに備える、請求項1〜請求項7のいずれか一項に記載のシステム。
- 前記流量制限器はニードル弁流量計である、請求項1〜請求項8のいずれか一項に記載のシステム。
- 前記人工肺は、密封されたハウジングを備えた膜型人工肺である、請求項1〜請求項9のいずれか1項に記載のシステム。
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WO2015047927A1 (en) | 2013-09-24 | 2015-04-02 | Gipson Keith | System and method for cardiopulmonary bypass using hypobaric oxygenation |
GB2557863B (en) | 2014-12-03 | 2020-09-16 | Spectrum Medical Ltd | Ventilation System |
WO2016168348A1 (en) * | 2015-04-13 | 2016-10-20 | Curtis Paul Stewart | Devices and methods for dynamic extracorporeal membrane oxygenation simulation |
CN107592818B (zh) * | 2015-05-13 | 2021-06-18 | 迈奎特心肺有限公司 | 一种临床参数计算模拟监测系统 |
CN108697840B (zh) | 2015-10-07 | 2022-05-13 | 迈奎特心肺有限公司 | 用户界面 |
ES2963184T3 (es) | 2016-08-01 | 2024-03-25 | Keith Gipson | Sistema para reducir microémbolos gaseosos mediante derivación sanguínea venosa con filtro |
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GB2561221A (en) * | 2017-04-06 | 2018-10-10 | Spectrum Medical Ltd | Oxygenation system |
GB2563062A (en) | 2017-06-02 | 2018-12-05 | Spectrum Medical Ltd | Oxygenation system |
EP3427772B1 (en) * | 2017-07-10 | 2023-05-03 | B. Braun Avitum AG | Oxygenator unit with a pressure relief valve |
DE102021129141A1 (de) | 2021-11-09 | 2023-05-11 | Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Körperschaft des öffentlichen Rechts | Anreicherung von Fluiden unter Druck mit Anreicherungsgas |
DE102022128054A1 (de) | 2022-10-24 | 2024-04-25 | ThrombShield UG (haftungsbeschränkt) | Vorrichtung zur extrakorporalen Filterung von Blut, Verfahren zur Durchführung einer extrakorporalen Membranoxygenierung, Verwendung einer Vorrichtung zur extrakorporalen Filterung und System für die extrakorporale Membranoxygenierung |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5591399A (en) * | 1993-10-14 | 1997-01-07 | Goldman; Julian M. | System for diagnosing oxygenator failure |
JP2001346871A (ja) * | 2000-04-11 | 2001-12-18 | Stoeckert Instr Gmbh | 圧縮流体により作動する制御部材を含む人工心肺 |
JP2012501797A (ja) * | 2008-09-11 | 2012-01-26 | ルナ イノベーションズ インコーポレイテッド | 流体から気泡を音響学的に増強して除去する方法及び装置 |
JP2013509238A (ja) * | 2009-10-29 | 2013-03-14 | アラング、テクノロジーズ、インコーポレイテッド | 酸素供給器からの水分をパージするための方法及びシステム |
Family Cites Families (24)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3142296A (en) | 1962-05-31 | 1964-07-28 | Jack W Love | Blood oxygenator |
FR2197565B1 (ja) * | 1972-08-30 | 1975-03-07 | Rhone Poulenc Ind | |
US4108607A (en) * | 1975-09-22 | 1978-08-22 | Baxter Travenol Laboratories, Inc. | Blood gas simulator |
IT1202689B (it) * | 1987-03-25 | 1989-02-09 | Franco Maria Montevecchi | Procedimento e dispositivo per la circolazione extracorporea del sangue e per assistenza cardiovascolare |
US5382407A (en) | 1988-12-14 | 1995-01-17 | Minnesota Mining And Manufacturing Company | Membrane blood oxygenator |
US5055198A (en) | 1990-03-07 | 1991-10-08 | Shettigar U Ramakrishna | Autologous blood recovery membrane system and method |
US5158534A (en) * | 1990-07-03 | 1992-10-27 | Cardiopulmonics, Inc. | Automated gas delivery system for blood gas exchange devices |
US5362406A (en) | 1990-07-27 | 1994-11-08 | Pall Corporation | Leucocyte depleting filter device and method of use |
EP0598424A3 (en) | 1992-11-16 | 1996-05-15 | Novellus Systems Inc | Apparatus for removing dissolved gases from a liquid. |
US6478962B1 (en) | 1995-12-13 | 2002-11-12 | Alexander Brockhoff | Dynamic bubble trap |
DE19750062A1 (de) | 1997-11-12 | 1999-05-20 | Jostra Medizintechnik Ag | Vorrichtung zur Filtration und Entgasung von Körperflüssigkeiten, insbesondere von Blut |
US6726651B1 (en) * | 1999-08-04 | 2004-04-27 | Cardeon Corporation | Method and apparatus for differentially perfusing a patient during cardiopulmonary bypass |
US6267926B1 (en) | 1998-10-08 | 2001-07-31 | Celgard Inc. | Device for removing entrained gases from liquids |
US6302860B1 (en) | 1999-02-17 | 2001-10-16 | Medtronic, Inc. | Venous filter for assisted venous return |
GB2358424B (en) | 1999-11-12 | 2004-04-28 | Carglass Luxembourg Sarl | Improvements in apparatus for and methods of damage repair |
US6582387B2 (en) | 2001-03-20 | 2003-06-24 | Therox, Inc. | System for enriching a bodily fluid with a gas |
GB0114227D0 (en) | 2001-06-12 | 2001-08-01 | Vivendi Water Systems Ltd | Improvements relating to degasing liquids |
US6596058B2 (en) | 2001-07-16 | 2003-07-22 | Systec, Inc. | Film degassing system |
US7204958B2 (en) * | 2003-01-14 | 2007-04-17 | Medtronic, Inc. | Extracorporeal blood circuit air removal system and method |
US7488448B2 (en) | 2004-03-01 | 2009-02-10 | Indian Wells Medical, Inc. | Method and apparatus for removal of gas bubbles from blood |
SE529519C2 (sv) * | 2005-03-24 | 2007-09-04 | Sifr 2000 Ab | Kontroll av bubbelbildning vid extrakorporeal cikulation |
US8734382B2 (en) | 2008-02-07 | 2014-05-27 | University of Pittsburgh—of the Commonwealth System of Higher Education | Intracorporeal gas exchange devices, systems and methods |
US8545754B2 (en) | 2009-04-23 | 2013-10-01 | Medtronic, Inc. | Radial design oxygenator with heat exchanger |
WO2015047927A1 (en) | 2013-09-24 | 2015-04-02 | Gipson Keith | System and method for cardiopulmonary bypass using hypobaric oxygenation |
-
2014
- 2014-09-22 WO PCT/US2014/056722 patent/WO2015047927A1/en active Application Filing
- 2014-09-22 JP JP2016517509A patent/JP6566935B2/ja active Active
- 2014-09-22 EP EP22189060.1A patent/EP4101481A1/en active Pending
- 2014-09-22 US US15/024,070 patent/US10335531B2/en active Active
- 2014-09-22 EP EP14849151.7A patent/EP3049126B1/en active Active
-
2019
- 2019-05-15 US US16/412,820 patent/US10668203B2/en active Active
- 2019-07-30 JP JP2019139851A patent/JP6846474B2/ja active Active
-
2020
- 2020-05-29 US US16/886,954 patent/US11738128B2/en active Active
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5591399A (en) * | 1993-10-14 | 1997-01-07 | Goldman; Julian M. | System for diagnosing oxygenator failure |
JP2001346871A (ja) * | 2000-04-11 | 2001-12-18 | Stoeckert Instr Gmbh | 圧縮流体により作動する制御部材を含む人工心肺 |
JP2012501797A (ja) * | 2008-09-11 | 2012-01-26 | ルナ イノベーションズ インコーポレイテッド | 流体から気泡を音響学的に増強して除去する方法及び装置 |
JP2013509238A (ja) * | 2009-10-29 | 2013-03-14 | アラング、テクノロジーズ、インコーポレイテッド | 酸素供給器からの水分をパージするための方法及びシステム |
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