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Balanced ultrafiltration: inflammatory mediator removal capacity.

Yulong Guan¹, Caihong Wan, Shigang Wang

¹Department of Extracorporeal Circulation, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. fuwaicpb@mx.cei.gov.cn

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Summary

Balanced ultrafiltration during pediatric cardiac surgery removes a limited portion of inflammatory mediators, with varying efficacy for different mediators like interleukin-1β and neutrophil elastase.

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Published on: February 13, 2016

Area of Science:

Cardiovascular Surgery
Biomedical Engineering
Immunology

Background:

Ultrafiltration is standard in pediatric cardiac surgery to manage fluid overload.
Balanced ultrafiltration aims to remove surgical inflammatory mediators, but its efficacy is uncertain.

Purpose of the Study:

To evaluate the in vitro removal capacity of zero-balanced ultrafiltration for inflammatory mediators during pediatric extracorporeal circulation.

Main Methods:

An in vitro extracorporeal circulation model was used with human whole blood.
Zero-balanced ultrafiltration was applied, and plasma/ultrafiltrate samples were analyzed for IL-1β, IL-6, IL-10, NE, and TNF-α concentrations.
Removal rates were calculated based on ultrafiltrate and plasma levels.

Main Results:

All tested inflammatory mediators were detected in the ultrafiltrate.
Neutrophil elastase (NE) showed the highest concentration, while IL-1β and TNF-α had the lowest in plasma and ultrafiltrate, respectively.
The overall removal percentages for inflammatory mediators were low, ranging from 0.24% for IL-10 to 4.17% for IL-1β.

Conclusions:

Zero-balanced ultrafiltration selectively removes some inflammatory mediators but removes only a limited fraction of the total inflammatory mediator load.
The hemoconcentrator's effectiveness in reducing the overall inflammatory burden during pediatric extracorporeal circulation is minimal.