Ultrafiltration and Modified Ultrafiltration in Cardiopulmonary Bypass Quiz

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Questions and Answers

What did Thomas Graham present a paper on in 1854?

Artificial kidney

Dialysis procedure

Anticoagulant derived from leeches

Osmotic Force (correct)

What is the pressure gradient that transmembrane pressure (TMP) should not exceed?

1000-1200 mm Hg

700-800 mm Hg

500-600 mm Hg (correct)

200-300 mm Hg

Who conducted the first clinical dialysis procedure in 1924?

George Haas (correct)

Leonard Skeggs

Willem Kolff

Richard Stewart

What does the sieving coefficient, ranging from 0 to 1.0, indicate?

The ability of a solute to be filtered through the ultrafiltrator membrane Signup and view all the answers

What material did Willem Kolff use to build an artificial kidney in the 1940s?

Regenerated cellulose membrane Signup and view all the answers

What does ultrafiltration remove in equal concentration to the plasma water?

Plasma water and diffusible solutes Signup and view all the answers

Who developed the flat or parallel plate dialyzer in 1947?

Leonard Skeggs and Jack Leonards Signup and view all the answers

What does ultrafiltration during cardiopulmonary bypass (CPB) particularly help with?

Removing excess fluid and concentrating blood without removing plasma proteins Signup and view all the answers

How is ultrafiltration achieved?

Filtration of water across a semipermeable membrane using the energy derived from a hydrostatic pressure gradient Signup and view all the answers

What factors determine the rate of fluid removal during ultrafiltration?

Membrane permeability, blood flow, TMP, and hematocrit Signup and view all the answers

What occurs during ultrafiltration in terms of solute removal?

Convection Signup and view all the answers

What is the hemoconcentrator or ultrafiltrator configured in parallel to?

The extracorporeal circuit Signup and view all the answers

What type of membrane material is commonly used in ultrafiltration during dialysis?

Microporous membrane material in a hollow fiber configuration Signup and view all the answers

When is a flowmeter recommended for more precise measurements during ultrafiltration?

Especially in pediatric patients Signup and view all the answers

What is the definition of ultrafiltration?

Movement of water across a membrane due to a pressure gradient Signup and view all the answers

What are ultrafiltration and dialysis primarily utilized to manage in patients undergoing CPB?

Blood volume, hemoglobin, protein, and certain electrolyte concentrations Signup and view all the answers

How do hemoconcentrators impact circulating concentrations of drugs and ions?

They increase the concentrations Signup and view all the answers

What do several studies suggest about the impact of ultrafiltration and dialysis on the systemic inflammatory response syndrome (SIRS)?

They may reduce mediators that initiate SIRS Signup and view all the answers

What is the primary difference between ultrafiltration and dialysis?

Ultrafiltration involves movement of water across a membrane, while dialysis involves removal of solutes from blood using a dialysate Signup and view all the answers

What creates a solute concentration gradient across the membrane during ultrafiltration?

Diffusion of water Signup and view all the answers

What is the primary purpose of ultrafiltration during cardiopulmonary bypass (CPB)?

To remove excess water and concentrate cellular elements and proteins in the blood Signup and view all the answers

What is the purpose of continuous ultrafiltration during rewarming on CPB?

To attenuate the inflammatory response and lower cytokine and complement levels Signup and view all the answers

What is the role of Z-BUF (Zero-Balance Ultrafiltration) in adults undergoing cardiac surgery?

To remove direct thrombin inhibitors like bivalirudin Signup and view all the answers

What is the purpose of Modified Ultrafiltration (MUF) in pediatric patients post-CPB?

To concentrate and transfuse residual circuit blood post-CPB without the risk of hypervolemia Signup and view all the answers

What can ultrafiltration remove from the blood during cardiopulmonary bypass (CPB)?

Direct thrombin inhibitors like bivalirudin Signup and view all the answers

How does Z-BUF ensure stable potassium levels during ultrafiltration?

Ultrafiltrate potassium levels are always in equal concentration to the plasma Signup and view all the answers

Why may protamine not be administered during Modified Ultrafiltration (MUF)?

To maintain circuit integrity Signup and view all the answers

What challenges presented by cardiopulmonary bypass (CPB) can be addressed through ultrafiltration?

Managing hemodilution, electrolyte levels, and fluid shifts due to the systemic inflammatory response Signup and view all the answers

How does Z-BUF contribute to post-CPB outcomes?

It has shown improved post-CPB outcomes and reduced levels of inflammatory mediators Signup and view all the answers

What can ultrafiltration efficiently remove compared to dialysis?

Middle-molecule uremic solutes Signup and view all the answers

Study Notes

Ultrafiltration and Modified Ultrafiltration in Cardiopulmonary Bypass

Ultrafiltration during cardiopulmonary bypass (CPB) aims to remove excess water, concentrate cellular elements, and proteins in the blood, while maintaining the patient's plasma concentration of diffusible solutes.
Continuous ultrafiltration during rewarming on CPB may attenuate the inflammatory response, as it can lower cytokine and complement levels, especially during this phase.
To enable continuous ultrafiltration during rewarming, ultrafiltrate is replaced with a balanced electrolyte solution.
Z-BUF (Zero-Balance Ultrafiltration) has been used to correct hyperkalemia, electrolyte, and acid-base disturbances in adults undergoing cardiac surgery.
Z-BUF ensures that as blood volume is reduced by ultrafiltration, potassium levels remain stable, as ultrafiltrate potassium levels are always in equal concentration to the plasma.
Modified Ultrafiltration (MUF) is a procedure used in pediatric patients to concentrate and transfuse residual circuit blood post-CPB without the risk of hypervolemia.
MUF requires patients to remain cannulated for 10 to 20 minutes post-CPB termination, and protamine may not be administered during MUF to maintain circuit integrity.
Ultrafiltration can remove direct thrombin inhibitors like bivalirudin, with the potential to remove 45% to 65% of the drug using MUF or UF for adults.
CPB presents challenges in managing hemodilution, electrolyte levels, and fluid shifts due to the systemic inflammatory response, all of which can be addressed through ultrafiltration.
Z-BUF, in combination with MUF, has shown improved post-CPB outcomes and reduced levels of inflammatory mediators.
The conventional dialysis circuit can be simplified for use in the extracorporeal circuit to manage patient volume and electrolyte imbalances, similar to Z-BUF or hemofiltration.
Ultrafiltration appears to efficiently remove middle-molecule uremic solutes compared to dialysis.

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Description

Test your knowledge of ultrafiltration and modified ultrafiltration in cardiopulmonary bypass with this quiz. Explore the uses, benefits, and techniques of ultrafiltration in managing hemodilution, electrolyte levels, and fluid shifts during CPB, as well as the application of Z-BUF and MUF in improving post-CPB outcomes.