Showing papers by "Robert H. Bartlett published in 2002"

The Molecular Adsorbents Recycling System as a Liver Support System Based on Albumin Dialysis: A Summary of Preclinical Investigations, Prospective, Randomized, Controlled Clinical Trial, and Clinical Experience from 19 Centers

Abstract: Artificial liver support aims to prolong survival time of patients with liver failure by detoxification. Albumin as a molecular adsorbent in dialysis solution is capable of attracting even tightly albumin-bound toxins from blood into the dialysate if a specific dialysis membrane is used and if the albumin's binding sites are on-line-purified by a sorbent/dialysis-based recycling system (i.e., molecular adsorbents recycling system, or MARS). The MARS technology has been shown to remove water-soluble and albumin-bound toxins and to provide renal support in case of renal failure. Fourteen centers have reported that MARS treatment improved mental status of patients with liver failure and hepatic encephalopathy. In treating liver failure and cholestasis, MARS was associated with hemodynamic stabilization, improvement of hepatic and kidney function, and disappearance of pruritus. In hepatic failure and hepatorenal syndrome, a prospective, randomized, controlled trial of MARS treatment was able to prolong survival time significantly. MARS has been used in 26 patients with acute liver failure or primary graft dysfunction. Nineteen centers reporting on 103 patients have shown that MARS treatment is safe, easy to handle, feasible, and effective.

Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome

Abstract: We evaluated the safety and efficacy of partial liquid ventilation (PLV) with perflubron in adult patients with acute lung injury and the acute respiratory distress syndrome (ARDS) in a multicenter, prospective, controlled, randomized exploratory clinical trial. Ninety adult patients with PaO2 /Fi O2 ratios > 60 and < 300 with ARDS for no more than 24 hours were randomized to receive PLV (n = 65) with administration of perflubron through an endotracheal tube sideport or conventional mechanical ventilation (CMV, n = 25) for a maximum of five days. Although a significant reduction in progression to ARDS was noted among patients with PLV, no significant differences in the number of days free from the ventilator at 28 days (CMV = 6.7 ± 1.8, PLV = 6.3 ± 1.0 days, p = 0.85), the incidence of mortality (CMV = 36%, PLV = 42%, p = 0.63), or any pulmonary-related parameter were observed. During a post hoc subgroup analysis, significantly more rapid discontinuation of mechanical ventilation (p = 0.045) and a trend t...

Extracorporal life support for pulmonary hemorrhage in children: a case series.

Abstract: Objective: To examine the use and outcome of extracorporeal life support in children with severe respiratory failure caused by pulmonary hemorrhage. Design: Retrospective case series report. Setting: Pediatric intensive care unit in a university children's hospital. Patients: Eight patients <19 yrs of age who required extracorporeal life support for severe respiratory failure associated with pulmonary hemorrhage. Interventions: Venoarterial or venovenous extracorporeal life support. Measurements: Ventilatory support parameters and systemic PaO 2 /FIO 2 ratio before extracorporeal life support, time on extracorporeal life support, number of ventilator days, number of intensive care unit days, number of hospital days, continued bleeding on extracorporeal life support, and survival. Main Results: All patients had resolution of their pulmonary hemorrhage within 24 hrs. All patients survived to decannulation, extubation, and hospital discharge. All patients are alive, with follow-up times ranging from 1 to 10 yrs. Conclusions: Extracorporeal life support is not contraindicated in patients with severe respiratory failure with associated pulmonary hemorrhage and may be a life-sustaining supportive therapy.

Increasing inspiratory time exacerbates ventilator-induced lung injury during high-pressure/high-volume mechanical ventilation.

Abstract: IntroductionVentilator-induced lung injury may be caused by overdistension of alveoli during high-pressure ventilation. In this study, we examined the effects of increasing inspiratory time on ventilator-induced lung injury.MethodsSprague-Dawley rats were divided into four different groups with ten

Results of an artificial-lung survey to lung transplant program directors.

Abstract: Background: Lung transplantation is the only treatment for patients with end-stage lung disease. However, the scarcity of donor organs illustrates the need for alternatives. Recent success in the use of ventricular assistance has stimulated research in technology designed as a bridge to lung transplantation. Some laboratories have demonstrated significant advances in the development of artificial lungs, and clinical applications are on the horizon. In preparation, we sought to gather information from the lung transplant community regarding issues related to testing and potential trials of artificial lungs. Methods: We constructed a survey and distributed it to lung transplant program directors recognized by the United Network for Organ Sharing. Topics included required animal studies, preferred designs, logistics of clinical trials, and patient diagnoses most appropriate for such a trial. Results: The 31 programs responding to the survey performed 72% of all lung transplants in the United States in 1999. Ninety-seven percent supported a Phase I trial using an artificial lung as a bridge to lung transplantation. Additionally, 58% specifically supported a trial in which organ allocation would be prioritized to enrolled patients. Idiopathic pulmonary fibrosis was the diagnosis thought most appropriate for inclusion in initial clinical trials. Conclusions: Widespread support exists for the development and use of an artificial lung as a bridge to lung transplantation. Information from transplant centers regarding device design and application can influence laboratories developing artificial lungs, and such communication will be essential as this technology progresses from the bench-top to the bedside.