European Heart Journal Advance Access originally published online on December 1, 2006
European Heart Journal 2007 28(10):1192; doi:10.1093/eurheartj/ehl398
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In-line filtration of intravenous fluids retains ‘spearhead’-shaped particles from the vascular system after open-heart surgery
PICU and Paediatric Cardiology, Medical School Hannover, Carl-Neuberg-Street 1, Hannover, Niedersachen 30625, Germany
* Corresponding author. Tel: +49 1774497696; fax: +49 5115329038. E-mail address: dr.bbrent{at}yahoo.de
Looking at the potential benefit of in-line filtration in reducing major complications occurring during intensive care unit stay, we would like to present the electron microscopy analysis of a filter used in a 17-year-old girl after aortic valve replacement. The patient received all drugs and fluids through a Pall Posidyne NEO filter with 0.2 µm pores size. Drugs given through the filter membrane included furosemide, spironolactone, hydrocortisone, ranitidine, paracetamol, and cefazoline by bolus injection or continuous infusion. The filter was used for 72 h before being removed and analysed. We were able to visualize 51 mm2 of the membrane's top layer by scanning electron microscopy and detected various particles of different size and shape adherent to the surface and the presented pictures were taken (Panels A–D). These images are representative of the size and shape of particles found, many of which are notable for their angular shape and crystalline appearance.
We hypothesize that microparticles, such as these, that would have been infused in the absence of the filter may cause severe local endothelial damage and possibly pre-dispose to complications such as respiratory distress syndrome, thrombosis and systemic inflammatory response syndrome, or, in the worst case, multiorgan dysfunction. We are therefore currently conducting a clinical trial to evaluate the potential benefit of microfilters in the paediatric intensive care setting.
The girl had an uneventful stay on the intensive care unit and was discharged to the ward after 36 h.
The authors would like to thank Dr Andreas Capewell for his role in analysing the microfilters and obtaining the electron micrographs of particles on the filter membrane.
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