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Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. METHODS: Following b...

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Autores principales: Estensen, Kristine, Shekar, Kiran, Robins, Elissa, McDonald, Charles, Barnett, Adrian G, Fraser, John F
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512975/
https://www.ncbi.nlm.nih.gov/pubmed/26266926
http://dx.doi.org/10.1186/s40635-014-0029-7
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author Estensen, Kristine
Shekar, Kiran
Robins, Elissa
McDonald, Charles
Barnett, Adrian G
Fraser, John F
author_facet Estensen, Kristine
Shekar, Kiran
Robins, Elissa
McDonald, Charles
Barnett, Adrian G
Fraser, John F
author_sort Estensen, Kristine
collection PubMed
description BACKGROUND: Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. METHODS: Following baseline sampling, known quantities of macro- and micronutrients were injected post oxygenator into ex vivo ECMO circuits primed with the fresh human whole blood and maintained under standard physiologic conditions. Serial blood samples were then obtained at 1, 30 and 60 min and at 6, 12 and 24 h after the addition of nutrients, to measure the concentrations of study compounds using validated assays. RESULTS: Twenty-one samples were tested for thirty-one nutrient compounds. There were significant reductions (p < 0.05) in circuit concentrations of some amino acids [alanine (10%), arginine (95%), cysteine (14%), glutamine (25%) and isoleucine (7%)], vitamins [A (42%) and E (6%)] and glucose (42%) over 24 h. Significant increases in circuit concentrations (p < 0.05) were observed over time for many amino acids, zinc and vitamin C. There were no significant reductions in total proteins, triglycerides, total cholesterol, selenium, copper, manganese and vitamin D concentrations within the ECMO circuit over a 24-h period. No clear correlation could be established between physicochemical properties and circuit behaviour of tested nutrients. CONCLUSIONS: Significant alterations in macro- and micronutrient concentrations were observed in this single-dose ex vivo circuit study. Most significantly, there is potential for circuit loss of essential amino acid isoleucine and lipid soluble vitamins (A and E) in the ECMO circuit, and the mechanisms for this need further exploration. While the reductions in glucose concentrations and an increase in other macro- and micronutrient concentrations probably reflect cellular metabolism and breakdown, the decrement in arginine and glutamine concentrations may be attributed to their enzymatic conversion to ornithine and glutamate, respectively. While the results are generally reassuring from a macronutrient perspective, prospective studies in clinical subjects are indicated to further evaluate the influence of ECMO circuit on micronutrient concentrations and clinical outcomes.
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spelling pubmed-45129752015-07-27 Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation Estensen, Kristine Shekar, Kiran Robins, Elissa McDonald, Charles Barnett, Adrian G Fraser, John F Intensive Care Med Exp Research BACKGROUND: Extracorporeal membrane oxygenation (ECMO) circuits have been shown to sequester circulating blood compounds such as drugs based on their physicochemical properties. This study aimed to describe the disposition of macro- and micronutrients in simulated ECMO circuits. METHODS: Following baseline sampling, known quantities of macro- and micronutrients were injected post oxygenator into ex vivo ECMO circuits primed with the fresh human whole blood and maintained under standard physiologic conditions. Serial blood samples were then obtained at 1, 30 and 60 min and at 6, 12 and 24 h after the addition of nutrients, to measure the concentrations of study compounds using validated assays. RESULTS: Twenty-one samples were tested for thirty-one nutrient compounds. There were significant reductions (p < 0.05) in circuit concentrations of some amino acids [alanine (10%), arginine (95%), cysteine (14%), glutamine (25%) and isoleucine (7%)], vitamins [A (42%) and E (6%)] and glucose (42%) over 24 h. Significant increases in circuit concentrations (p < 0.05) were observed over time for many amino acids, zinc and vitamin C. There were no significant reductions in total proteins, triglycerides, total cholesterol, selenium, copper, manganese and vitamin D concentrations within the ECMO circuit over a 24-h period. No clear correlation could be established between physicochemical properties and circuit behaviour of tested nutrients. CONCLUSIONS: Significant alterations in macro- and micronutrient concentrations were observed in this single-dose ex vivo circuit study. Most significantly, there is potential for circuit loss of essential amino acid isoleucine and lipid soluble vitamins (A and E) in the ECMO circuit, and the mechanisms for this need further exploration. While the reductions in glucose concentrations and an increase in other macro- and micronutrient concentrations probably reflect cellular metabolism and breakdown, the decrement in arginine and glutamine concentrations may be attributed to their enzymatic conversion to ornithine and glutamate, respectively. While the results are generally reassuring from a macronutrient perspective, prospective studies in clinical subjects are indicated to further evaluate the influence of ECMO circuit on micronutrient concentrations and clinical outcomes. Springer International Publishing 2014-11-22 /pmc/articles/PMC4512975/ /pubmed/26266926 http://dx.doi.org/10.1186/s40635-014-0029-7 Text en © Estensen et al.; licensee Springer. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Research
Estensen, Kristine
Shekar, Kiran
Robins, Elissa
McDonald, Charles
Barnett, Adrian G
Fraser, John F
Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
title Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
title_full Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
title_fullStr Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
title_full_unstemmed Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
title_short Macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
title_sort macro- and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512975/
https://www.ncbi.nlm.nih.gov/pubmed/26266926
http://dx.doi.org/10.1186/s40635-014-0029-7
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