A novel approach to the treatment of chronic fluid overload with a new plasma separation device.

摘要

Many patients with congestive heart failure suffer at some point in their therapy from severe fluid overload, and a significant proportion of patients become unresponsive to diuretic drug therapy. In this paper, we propose a new experimental approach to plasma purification and the treatment of severe fluid overload in acute care patients. Plasma can be extracted directly from the patient through an intracorporeal catheter temporarily placed within the inferior vena cava. Plasma separation is accomplished through a proprietary membrane placed on the tip of the catheter. A simple circuit performs plasma removal. The extracted plasma is then available for any type of treatment before being returned to the patient via a second lumen in the same catheter. Plasma flow rates between 3 and 8 ml/min have been achieved and animal tests led to the removal of more than 2,000 ml of plasma water in 24 h. The current varieties of blood purification or ultrafiltration techniques employ extracorporeal extraction of blood from the patient in order to perform treatment. Removal of the cellular component in the extracorporeal fluid circuit may reduce the current problems associated with extracorporeal circuits, such as cellular lysis and viscosity-related problems. Plasma treatment is already successfully performed in a variety of therapies, including renal replacement therapies and plasmapheresis. The therapy proposed here may extend the utility of plasma treatment to the acute cardiology patient. The system could become an important complementary therapy for patients with congestive heart failure for whom classic methods of treatment have failed or simply are not available.