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Respiratory Dialysis

Respiratory Dialysis , concept needing a serious look : The RDS Group.

The Central Idea of Respiratory Dialysis Research Group:

• Our Group RDS is non profit making organization.

• Primarily dedicated to research and promotional activities in relation to furthering the


concept of respiratory dialysis.

The Core Concept of respiratory dialysis?

• For ages one has been thinking of treating hypoxemia by oxygenation through lungs.

• It is a well known fact that oxygen is deleterious to lungs and specially to injured lungs
and the group firmly believes that exposing lungs to high concentration of oxygen and time
at high pressure could be harmful.

• Lungs when injured would need some healing time and exposing them to high
concentration and pressure of oxygen may in fact delay this basic aim of therapy.

• · The RDS group has been formed to promote new concept and research in the
direction of offering partial support to respiratory system through the membrane
other than lung.

• We would appreciate if you can give a patient thought to our selfless concept and
unique idea, undertaken for the benefit of mankind and help us in spreading the word
further.

What is Respiratory Failure?

As we know Respiratory failure is the inability of the lungs to perform their basic task
of gas exchange, the transfer of oxygenfrom inhaled air into the blood and the transfer of
carbon dioxide from the blood into exhaled air.

Causes

A host of medical conditions can lead to respiratory failure, like

• A long history of asthma, emphysema, chronic obstructive disease.


• Major surgery on the abdomen, heart, or lungs

• An overdose of sleeping pills or certain depressant drugs

• A premature baby weighing less than 3 pounds

• A baby suffering from broncho pulmonary dysplasia

• Severe Physical Injuries ,Severe Burns

• Profuse bleeding, drowning, heart failure.

• Severe infection, such as AIDS

• Obesity to an extreme level.

Our Thought

1. 1. It is our constant endeavor to work on the central idea of the possibility of


providing partial support to respiratory system through the membrane other than
lung.

2. 2. An attempt is made to utilize the available membrane in the body.

3. 3. The concept is similar to renal dialysis.

4. 4. Our main area of concern is ARDS as also observed in children.

Respiratory Dialysis – The Core Issue Representing the Original Thought

THE ORIGINATION OF THOUGHT

The original thought came while observing an earth worm. It is wonderful that in
earthworm the entire respiration is through the skin. An earthworm has no respiratory
organ. It takes in oxygen directly through its skin and gives off carbon dioxide.
Earthworms rely on their moist bodies for oxygen to diffuse into the blood circulating
near the surface of their skin. The reason that earthworms come to the surface when the
ground is water saturated is because it needs the air circulating in the soil to diffuse
enough oxygen into their blood.

Another support for this theory is the respiratory system of the amphibian Frog, as partial
support for respiration through skin is seen possible in frog. An extensive network of
blood vessels runs throughout the frog’s skin. Oxygen can pass through the membranous
skin, thereby entering directly into the blood. When a frog submerges beneath the water,
all its respiration takes place through the skin. Oxygen is obtained directly from the
water. Though it can breathe by simply opening its mouth and letting air flow into its
windpipe.

The Core Issue……

1. Exposing lungs to high% or higher pressure of oxygen.

2. Respiratory failure when necessary is treated with supporting oxygenation through


lungs.

3. In most situations the lungs are damaged and they are exposed to high concentrations
of oxygen.

4. At times lungs are exposed to supra normal pressure. This is done with full knowledge,
accepting the risk of life threatening risk of air leak and known risk of broncho pulmonary
dysplasia.

Let us analysis with some questions and their answers

Q.1. The question that arises is “Is there no alternative to getting oxygen in the
body and also save the lungs?”

• At the moment we are possibly blocked with the idea that there is no alternative to the
lungs as source of oxygen even if they are damaged and even if this means significant
amount of risk to life.

Q. 2 Secondly we ask “Is there no surface which could take at least partly
over the function of gas exchange?”

• If oxygen could be transported through skin or other membrane in the body in


significant amount this would mean we would increase the vena cava oxygen concentration
and there are references showing increasing the arterial oxygenation by improving the
venous oxygen concentration.

• Intravenous oxygenators have been tried and they do result in increasing the arterial
oxygenation.

Q. 3 Does that mean – that we by pass the lung completely?

• At the moment what we expect from such a surface is a part support to say
oxygenation.
• Patient with PaO2 of around 40 and on ventilatory settings which don’t look very good
have an option to either accept the risk of ventilator associated lung injury or may be die of
hypoxemia.

• Such patients may be benefited at the moment by a hypothetical concept of driving


oxygen through membrane other than lung and let the lungs be ventilated with safe settings
and hope this combination pulls him through the crisis.

Ultimately the answer to this question at the moment is no, we don’t by pass the lung
completely but try and look for a membrane through which oxygen may be driven in.

Which Membrane do we look for to drive the oxygen in the body?

We at RDS thought on what membrane? and which membrane do we look for to


drive the oxygen.

We concluded that

• Laparoscopist,s know this well that carbon dioxide easily passes through peritoneum
and the moment carbon dioxide is put in the peritoneal cavity end tidal CO2 increases.

• Can the reverse happen? Can oxygen go through the peritoneum?

• If this happens our patients with respiratory failure would be treated by nephrologists
rather than by intensivists.

Any other membrane can be thought, we have studied skin as a membrane for
oxygen transport.

How the Oxygen can transport through Skin?

• · What can be done to facilitate transport of oxygen through skin?

1) Exposing skin to high pressure of oxygen, hyperbaric oxygen.

2) Utilizing more than one membrane at the same time.

3) Changing the property of the membrane by some mechanism.

• · What could the special advantage to neonates?


1) Neonates have a larger skin surface and the skin is relatively thin, this is specially
so in preterm babies and may be oxygenation through skin along with the conventional
means would help in tiding over the crisis.

2) Special interests would be if at some time in future it is possible to oxygenate


through skin.

3) Hyperoxia is unlikely to happen.

Studies have shown that oxygen does go through capillaries to skin ….

What are the big advantages?

4) Helps greatly in preventing and minimizing the lung injury.

5) Shorten the duration of illness

6) Prevent or minimizes the lung infections caused by ventilator.

7) May help in reducing the complications of airway handling.

8) Hyperoxia is unlikely.

9) Sedation, paralyzing agents minimized.

10) Patient can feel more comfortable.

11) Patient can feel recuperating and more ambulatory.

What would be the limiting factors or the disadvantages?

1. May or may not work, but good circulation would be mandatory.

2. In patients with shock this would almost certainly not work, until the efforts are made
to improve the circulation.

What we expect from you?

1) With open mind give a thought to the issue of trans cutenious gas transport, it may
or may not work but surely needs a serious attention.
2) Contribute your ideas, and if you know some one who has similar interests please
let us know.

3) This is a non profit making organization and we would welcome some one who
could help us grow with their support.

4) We expect you to put in your remarks on the contact usdeopujaris@gmail.com

5) Even if the remarks are contrary to what we think, please pen them for us.