C-reactive protein in water leakage from gas exhaust of polypropylene oxygenators,The Cardiothoracic Surgeon

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C-reactive protein in water leakage from gas exhaust of polypropylene oxygenators
The Cardiothoracic Surgeon Pub Date : 2021-01-07 , DOI: 10.1186/s43057-020-00038-9
Ignazio Condello , Alessandro Fiorentino , Giuseppe Santarpino , Massimiliano Manno , Giuseppe Speziale

We present the results of C-reactive protein (CRP) on condensation and water loss from gas outlet of oxygenator during cardiopulmonary bypass (CPB).

According to these previous studies, blood plasma can evaporate at the liquid–membrane interface and diffuse as water vapor diffuses across the pores into the intraluminal gas phase [1].

In this correspondence, we emphasize that little is known about the propagation of the condensation formed at the level of oxygenator and how potentially it can contaminate the surrounding environment. We have recently quantified the production of water vapor produced by the oxygenators, comparing different types of polypropylene fibers for conventional CPB and polymethylpentene (PMP) for ECMO management, with different results in oxygenation in relation to temperature management and to the evacuation with negative pressure of the oxygenator gas outlet. The aspiration use in the gas outlet could favor both the elimination of condensation, particularly in PMP oxygenators, and gas exchange. In other words, if the heat exchanger of the oxygenator was used for a long time, this resulted in an increased production of steam and a reduced oxygenating performance with an accumulation of condensed liquid of 6 mL after 120 min [2]. Our analysis, which sets a cutoff at 120 min, suggests trying to contain CPB time, but if the intervention requires longer CPB times, this obviously will be done without limiting the completeness and accuracy of the procedure.

In the human body, amyloids have been linked to the development of various diseases. About 10% of amyloid deposits are made up of C-reactive protein (7–13 nm in diameter), normally found in the blood, which increases in inflammatory states [2].

Twenty water loss samples were collected at the Anthea Hospital institution for the polypropylene fiber oxygenating modules (10 inspire 6F, LivaNova, UK, and 10 Alone, Eurosets, IT), after 120 min of extracorporeal circulation during cardiac surgery procedures. For samples, we used a sterile tube connected to the gas outlet of oxygenator to a sterile container subjected to control negative pressure of − 8 mmHg [2]. Six milliliters of condensate was collected per oxygenator at the end of the procedures, which were subjected to a quantitative spectrophotometric determination of C-reactive protein (CRP). The analysis was performed on an automated AU480 analyzer by Beckman Coulter with a turbidimetric method; the measurement of the decrease in the intensity of the light transmitted through suspended particles in solution is the result of complexes formed during the antigen-anti-CRP antibody reaction. In the 20 condensate samples analyzed for the quantitative spectrophotometric determination of C-reactive protein (CRP), for samples was found 0.15 (± 0.3) mg/L almost 10% of the serum value. These measured values show indirectly a possible smaller pathogen passage with condensation through polypropylene oxygenator fiber; however, further investigations are needed to confirm these preliminary results.

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CRP:: C-reactive protein
CPB:: Cardiopulmonary bypass
PMP:: Polymethylpentene
ECMO:: Extracorporeal membrane oxygenation

1.
Condello I (2020) Water condensation and gas exchange correlation in different models and fibers of blood oxygenators: “how can we improve performance?”. J Extra Corpor Technol 52(1):43–51
PubMed PubMed Central Google Scholar
2.
Aouifi A, Piriou V, Blanc P et al (1999) Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations. Br J Anaesth 83(4):602–607
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Affiliations

Department of Cardiac Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
Ignazio Condello, Giuseppe Santarpino & Giuseppe Speziale
GVM Care & Research, Perfusion Service, Anthea Hospital, Via Camillo Rosalba 35/37, 70124, Bari, Italy
Ignazio Condello
Department of Cardiac Surgery, GVM Care & Research, Città di Lecce, Lecce, Italy
Alessandro Fiorentino
Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
Giuseppe Santarpino
Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
Giuseppe Santarpino
Laboratorio Analisi, GVM Care&Research, Città di Lecce Hospital, Lecce, Italy
Massimiliano Manno

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Ignazio CondelloView author publications
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Alessandro FiorentinoView author publications
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Giuseppe SantarpinoView author publications
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Massimiliano MannoView author publications
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Giuseppe SpezialeView author publications
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Contributions

IC designed the work with the acquisition analysis and interpretation of data. AF gives supervision and support for the data collection. GS did the statistical analysis and language support. MM gave contribution for the laboratory analysis and data interpretation. GS gave supervision and logistic support. The authors read and approved the manuscript.

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Correspondence to Ignazio Condello.

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Condello, I., Fiorentino, A., Santarpino, G. et al. C-reactive protein in water leakage from gas exhaust of polypropylene oxygenators. Cardiothorac Surg 29, 1 (2021). https://doi.org/10.1186/s43057-020-00038-9

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Received: 18 November 2020
Accepted: 20 December 2020
Published: 07 January 2021
DOI: https://doi.org/10.1186/s43057-020-00038-9

中文翻译：

聚丙烯氧合器排气中漏水中的C反应蛋白

我们介绍了C反应蛋白（CRP）在体外循环（CPB）期间从充氧器气体出口凝结和水分流失的结果。

根据这些先前的研究，血浆可以在液膜界面蒸发并随着水蒸气通过孔扩散进入腔内气相而扩散[1]。

在这种对应关系中，我们强调对在充氧器水平上形成的冷凝物的传播及其可能污染周围环境的知之甚少。最近，我们量化了充氧器产生的水蒸气的产生量，比较了用于常规CPB的不同类型的聚丙烯纤维和用于ECMO管理的聚甲基戊烯（PMP），在温度管理和负压抽真空方面的充氧效果不同。充氧器气体出口。在气体出口使用吸气既可以消除冷凝（尤其是在PMP充氧器中），也可以促进气体交换。换句话说，如果充氧器的热交换器长时间使用，120分钟后，这会导致蒸汽产量增加和氧合作用降低，冷凝液积聚为6 mL [2]。我们的分析将截止时间定为120分钟，建议尝试限制CPB时间，但是如果干预需要更长的CPB时间，显然可以做到这一点而不会限制该过程的完整性和准确性。

在人体中，淀粉样蛋白与各种疾病的发展有关。大约10％的淀粉样蛋白沉积物由C反应蛋白（直径7-13 nm）组成，通常在血液中发现，在炎症状态下会增加[2]。

在心脏外科手术过程中进行体外循环120分钟后，在Anthea医院机构收集了20个失水样品用于聚丙烯纤维充氧模块（10 Inspire 6F，英国LivaNova，10 Alone，Eurosets，IT）。对于样品，我们使用连接到充氧器出气口和无菌容器的无菌管，该无菌容器承受− 8 mmHg的负压[2]。在程序结束时，每个充氧器收集到6毫升冷凝液，然后对C反应蛋白（CRP）进行分光光度定量测定。该分析是由贝克曼库尔特（Beckman Coulter）在自动AU480分析仪上采用比浊法进行的；通过溶液中的悬浮颗粒传输的光强度降低的测量结果是抗原-抗CRP抗体反应过程中形成复合物的结果。在分析的20个冷凝液样品中，用于分光光度法测定C反应蛋白（CRP），发现样品的0.15（±0.3）mg / L几乎是血清值的10％。这些测量值间接表明病原体通过聚丙烯氧合器纤维凝结时可能会传播的更小；但是，需要进一步调查以确认这些初步结果。这些测量值间接显示出病原体通过聚丙烯充氧器纤维凝结时可能较小的通行性。但是，需要进一步调查以确认这些初步结果。这些测量值间接表明病原体通过聚丙烯氧合器纤维凝结时可能会传播的更小；但是，需要进一步调查以确认这些初步结果。

不适用

CRP：: C反应蛋白
CPB：: 心肺旁路
PMP：: 聚甲基戊烯
ECMO：: 体外膜氧合

1。
Condello I（2020）在不同型号和血液氧合剂纤维之间的水冷凝和气体交换相关性：“我们如何改善性能？”。J Extra Corpor Technol 52（1）：43–51
PubMed PubMed Central Google学术搜索
2。
Aouifi A，Piriou V，Blanc P等人（1999年）体外循环对血清降钙素和C反应蛋白浓度的影响。Br J Anaesth 83（4）：602–607
CAS文章Google学术搜索

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隶属关系

意大利巴里市Anthea医院GVM护理与研究中心心脏外科
Ignazio Condello，Giuseppe Santarpino和Giuseppe Speziale
GVM护理与研究，Anthea医院灌注服务，Via Camillo Rosalba 35 / 37，70124，意大利巴里
伊格纳西奥·康德洛
意大利莱切城堡（Cittàdi Lecce），GVM护理与研究中心，心脏外科
亚历山德罗·菲奥伦蒂诺
德国纽伦堡Paracelsus医科大学心脏外科
朱塞佩·桑塔皮诺
意大利卡坦扎罗卡坦扎罗大学“ Magna Graecia”大学实验和临床医学系心脏外科
朱塞佩·桑塔皮诺
意大利莱切城堡城医院GVM护理与研究实验室Laboratorio Analisi
马西米利亚诺·曼诺（Massimiliano Manno）

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会费

IC设计了具有采集功能的数据分析和解释功能。AF对数据收集提供监督和支持。GS进行了统计分析和语言支持。MM为实验室分析和数据解释做出了贡献。GS提供了监督和后勤支持。作者阅读并批准了手稿。

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