James Ploessl | PubMed Health

PubMed2005

Hemicolectomy with concomitant heated intraperitoneal chemotherapy: a case study.

The use of heated intraperitoneal chemotherapy is an emerging new adjunct in the treatment of adenocarcinoma of the colon. However, documentation regarding perfusion circuitry and techniques associated with this therapy remain largely undescribed. After consultation with the surgical service team, a custom designed circuit was constructed for this procedure. Institutional approval and informed consent were obtained for surgical debulking and heated intraperitoneal chemotherapy for a 58-year old female. After surgical resection, a right hemicolectomy was performed and pathological specimens obtained. A modified custom circuit using a roller pump was first primed with 3 liters of Dianeal PD-2 and recirculated until temperature of 41 degrees C was obtained. The circuit was then connected to the patient for infusion of perfusate via Blake drains placed in the deep pelvis. Two additional drains were placed in the subdiaphragmatic space for return. Perfusate containing 30 mg of Mitomycin-C was circulated at 600-800 mL/min for 60 min at 41 degrees C. An additional 10 mg of Mitomycin-C was then administered through the circuit for an additional hour under similar conditions. Upon completion, a washout procedure was performed with 2 additional liters of Dianeal PD-2. The patient tolerated the procedure well and was discharged postoperative day 7. We describe the successful use of a perfusion-administered heated intraperitoneal chemotherapy regimen as an integral part of successful treatment of adenocarcinoma of the colon.

Adenocarcinoma↗

PubMed2005

Use of the CDI blood parameter monitoring system 500 for continuous blood gas measurement during extracorporeal membrane oxygenation simulation.

UNLABELLED: The Oximetrix III Opticath (Abbott Critical Care Systems) is used for continuous measurement of venous saturation in a variety of applications, including extracorporeal membrane oxygenation (ECMO), despite clinical reports that have presented data showing poor accuracy of these devices. The CDI Blood Parameter Monitoring System 500 (Terumo) is an inline blood gas monitoring tool commonly used during cardiopulmonary bypass procedures to continuously assess oxygen saturation, blood gases, potassium, and bicarbonate. The purpose of this experiment was to compare the Opticath and the CDI 500 in trending venous blood saturation during a simulation of ECMO. An ECMO simulation circuit consisting of a silicone rubber membrane oxygenator and a stainless steel heat exchanger was constructed, and a standard venous reservoir bag was used to represent the patient. The CDI and the Opticath were incorporated side by side into a shunt that originated just before the oxygenator and returned flow to the venous line. The circuit was primed with fresh porcine blood and conditioned with the addition of CO2 to simulate typical venous blood under ECMO conditions. After an initial calibration procedure, samples were drawn and analyzed by an AVL Opti CCA (Roche/Osmetech) every 4-8 hours for a period of 7 days, with calibration of each device at sample intervals. The data were plotted, and a least squares regression line was calculated. The average error for venous saturation of the CDI and Opticath after 72 hours was 3.86 and 9.51 respectively. At 168 hours, error for the CDI was 8.37, and the Opticath had an error of 14.78. A correlation analysis of the CDI and AVL CCA analyzer yielded a correlation coefficient of r = .88 at 72 hours and r = .84 at 168 hours. Correlation between the Opticath and the AVL CCA yielded a correlation coefficient of r = .77 at 72 hours and r = .55 at 168 hours. Based on these findings, the CDI 500 is an effective tool for monitoring venous blood saturation under simulated conditions of ECMO. KEYWORDS: CDI 500, Opticath, extracorporeal membrane oxygenation, venous saturation.

Blood Gas Analysis↗