Search results for: extracorporeal membrane oxygenation (ECMO)

Authors: Kristel Dame Bañez Sumagaysay, Marie Victoria Cruz-javier

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The current subject is a case of a 21 year-old woman at 29 1/7 weeks of gestation with Pre-B cell Acute Lymphoblastic Leukemia who was admitted to the coronary care unit (CCU) of the St. Luke’s Medical Center-Global City for Severe Acute Respiratory Distress Syndrome (ARDS) secondary to hospital-acquired pneumonia secondary to pneumocystis jiroveci; central line-associated bloodstream infection (E. aerogenes). She presented with chronic hypoxemia caused by Pulmonary edema, probably secondary to heart failure secondary to cardiomyopathy chemotherapy-induced. Due to worsening feto-maternal status, extracorporeal membrane oxygenation (ECMO) for respiratory support was instituted, and an elective cesarean section was done due to multiple maternal factors and deteriorating health status under total intravenous anesthesia assisted by veno-venous extracorporeal membrane oxygenation. She delivered a live preterm newborn male, APGAR Score: 1, 0, 0, birth weight 985 grams, birth length: 40.5cm, small for gestational age.

Keywords: extracorporeal membrane oxygenation, pre-b cell acute lymphoblastic leukemia, severe acute respiratory distress syndrome, ethical dilemmas

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Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

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Authors: Yu-Chen Hsu, Kuang C. Lin

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The artificial lung called extracorporeal membrane oxygenation (ECMO) is an important medical machine that supports persons whose heart and lungs dysfunction. Previously, investigation of steady deoxygenated blood flows passing through hollow fibers for oxygen transport was carried out experimentally and computationally. The present study computationally analyzes the effect of biological pulsatile flow on the oxygen transport in blood. A 2-D model with a pulsatile flow condition is employed. The power law model is used to describe the non-Newtonian flow and the Hill equation is utilized to simulate the oxygen saturation of hemoglobin. The dimensionless parameters for the physical model include Reynolds numbers (Re), Womersley parameters (α), pulsation amplitudes (A), Sherwood number (Sh) and Schmidt number (Sc). The present model with steady-state flow conditions is well validated against previous experiment and simulations. It is observed that pulsating flow amplitudes significantly influence the velocity profile, pressure of oxygen (PO2), saturation of oxygen (SO2) and the oxygen mass transfer rates (m ̇_O2). In comparison between steady-state and pulsating flows, our findings suggest that the consideration of pulsating flow in the computational model is needed when Re is raised from 2 to 10 in a typical range for flow in artificial lung.

Keywords: artificial lung, oxygen transport, non-Newtonian flows, pulsating flows

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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Authors: Byung Keun Yang, Jae Eun Ku, Young Seon Joo, Je Sung You, Sung Phil Chung, Hahn Shick Lee

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The purpose of this study is to review the evidence comparing the efficacy and safety between L-carnitine and extracorporeal elimination therapy in the management of acute valproic acid L-carnitine vs Extracorporeal Elimination for Acute Valproic acid Intoxication. PubMed, Embase, Cochrane library, Web of Science, KoreaMed, KMbase, and KISS were searched, using the terms carnitine and valproic acid. All studies, regardless of design, reporting efficacy or safety endpoints were included. Reference citations from identified publications were reviewed. Both English and Korean languages were included. Two authors extracted primary data elements including poisoning severity, presenting features, clinical management, and outcomes. Thirty two articles including 33 cases were identified. Poisoning severity was classified as 3 mild, 11 moderate, and 19 severe cases. Nine cases were treated with L-carnitine while 24 cases received extracorporeal therapy without L-carnitine. All patients except one expired patient treated with hemodialysis recovered clinically and no adverse effects were noted. A case report comparing two patients who ingested the same amount of valproic acid showed increased ICU stay (3 vs. 11 days) in case of delayed extracorporeal therapy. Published evidence comparing L-carnitine with extracorporeal therapy is limited. Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose. In case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.

Keywords: carnitine, overdose, poisoning, renal dialysis, valproic acid

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Authors: Elizabeth Laguaite, Alexandria Purdy

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Heart transplant recipients face psycho-physiological stressors, including pain, lengthy hospitalizations, delirium, and existential crises. They pose an increased risk for Post Traumatic Stress Disorder (PTSD) and can be a predictor of poorer mental and physical Health-Related Quality of Life (HRQOL) outcomes and increased mortality. There is limited research on the prevention of Post Traumatic Stress Symptoms (PTSS) in transplant patients. This case report focuses on a collaborative Music and Art Therapy intervention used to improve outcomes for HMH transplant recipient John (Alias). John, a 58-year-old man with congestive heart failure, was admitted to HMH in February of 2021 with cardiogenic shock, cannulated with an Intra-aortic Balloon Pump, Impella 5.5, and Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a bridge to heart and kidney transplant. He was listed as status 1 for transplant. Music Therapy and Art Therapy (MT and AT) were ordered by the physician for mood regulation, trauma processing and anxiety management. During MT/AT sessions, John reported a history of anxiety and depression exacerbated by medical acuity, shortness of breath, and lengthy hospitalizations. He expressed difficulty sleeping, pain, and existential questions. Initially seen individually by MT/AT, it was determined he could benefit from a collaborative approach due to similar thematic content within sessions. A Life Review intervention was developed by MT/AT. The purpose was for him to creatively express, reflect and process his medical narrative, including the identification of positive and negative events leading up to admission at HMH, the journey to transplant, and his hope for the future. Through this intervention, he created artworks that symbolized each event and paired them with songs, two of which were composed with the MT during treatment. As of September 2023, John has not been readmitted to the hospital and expressed that this treatment is what “got him through transplant”. MT and AT can provide opportunities for a patient to reminisce through creative expression, leading to a shift in the personal meaning of these experiences, promoting resolution, and ameliorating associated trauma. The closer to trauma it is processed, the less likely to develop PTSD. This collaborative MT/AT approach could improve long-term outcomes by reducing mortality and readmission rates for transplant patients.

Keywords: art therapy, music therapy, critical care, PTSD, trauma, transplant

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

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Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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Authors: Siu Hua Chang, Ayub Md Som, Jagannathan Krishnan

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The kinetics of Cu(II) transport through a bulk liquid membrane with different membrane materials was investigated in this work. Three types of membrane materials were used: Fresh cooking oil, waste cooking oil, and kerosene each of which was mixed with di-2-ethylhexylphosphoric acid (carrier) and tributylphosphate (modifier). Kinetic models derived from the kinetic laws of two consecutive irreversible first-order reactions were used to study the facilitated transport of Cu(II) across the source, membrane, and receiving phases of bulk liquid membrane. It was found that the transport kinetics of Cu(II) across the source phase was not affected by different types of membrane materials but decreased considerably when the membrane materials changed from kerosene, waste cooking oil to fresh cooking oil. The rate constants of Cu(II) removal and recovery processes through the bulk liquid membrane were also determined.

Keywords: transport kinetics, Cu(II), bulk liquid membrane, waste cooking oil

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Authors: Thendiyath Roshni, Stefano Pagliara

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Block ramps (BR) or rock chutes are eco-friendly natural river restoration structures. BR are made of ramp of rocks and flows over BR develop turbulence and helps in the entrainment of ambient air. These act as natural aerators in river flow and therefore leads to oxygenation of water. As many of the hydraulic structures in rivers, hinders the natural path for aquatic habitat. However, flows over BR ascertains a natural rocky flow and ensures safe and natural movement for aquatic habitat. Hence, BR is considered as a better alternative for drop structures. As water quality is concerned, turbulent and aerated flows over BR or macro-roughness conditions improves aeration and thereby oxygenation. Hence, the objective of this paper is to study the oxygenation in the turbulent flows over BR. Experimental data were taken for a slope (S) of 27.5% for three discharges (Q = 9, 15 and 21 lps) conditions. Air concentration were measured with the help of air concentration probe for three different discharges in the uniform flow region. Oxygen concentration is deduced from the air concentration as ambient air is entrained in the flows over BR. Air concentration profiles and oxygen profiles are plotted in the uniform flow region for three discharges and found that air concentration and oxygen concentration does not show any remarkable variation in properties in the longitudinal profile in uniform flow region. An empirical relation is developed for finding the average oxygen concentration (Oₘ) for S = 27.5% in the uniform flow region for 9 < Q < 21 lps. The results show that as the discharge increases over BR, there is a reduction of oxygen concentration in the uniform flow region.

Keywords: aeration, block ramps, oxygenation, turbulent flows

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Authors: Fatma Khaled, Khaoula Hidouri, Bechir Chaouachi

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Desalination using solar energy coupled with membrane techniques such as vacuum membrane distillation (VMD) is considered as an interesting alternative for the production of pure water. During this work, a developed model of a polytetrafluoroethylene (PTFE) hollow fiber membrane module of a VMD unit of seawater was carried out. This simulation leads to establishing a comparison between the effects of two different equations of the vaporization latent heat on the membrane surface temperature and on the unit productivity. Besides, in order to study the effect of putting membrane modules in series on the outlet fluid temperature and on the productivity of the process, a simulation was executed.

Keywords: vacuum membrane distillation, membrane module, membrane temperature, productivity

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Authors: Hanan Alenezi

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Membrane performance depends on the kind of solvent used in preparation. A membrane made by Polyetherimide (PEI) was evaluated for gas separation using X-Ray Diffraction (XRD), Scanning electron microscope (SEM), and Energy Dispersive X-Ray Spectroscopy (EDS). The purity and the thickness are detected to evaluate the membrane in order to optimize PEI membrane preparation.

Keywords: Energy Dispersive X-Ray Spectroscopy (EDS), Membrane, Polyetherimide PEI, Scanning electron microscope (SEM), Solvent, X-Ray Diffraction (XRD)

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Authors: E. S. Johal, M. S. Saini, M. K. Jha

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Currently, 1.1 billion people are at risk due to lack of clean water and about 35 % of people in the developed world die from water related problem. To alleviate these problems water purification technology requires new approaches for effective management and conservation of water resources. Electrospun nanofibres membrane has a potential for water purification due to its high large surface area and good mechanical strength. In the present study PAMAM dendrimers composite nynlon-6 nanofibres membrane was prepared by crosslinking method using Glutaraldehyde. Further, the efficacy of the modified membrane can be renewed by mere exposure of the saturated membrane with the solution having acidic pH. The modified membrane can be used as an effective tool for water purification.

Keywords: dendrimer, nanofibers, nanocomposite membrane, water purification

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Authors: Ngozi Claribelle Nwogu, Mohammed Nasir Kajama, Godson Osueke, Edward Gobina

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A unique sol–gel dip-coating process to form an asymmetric silica membrane with improved membrane performance and reproducibility has been reported. First, we deposited repeatedly a silica solution on top of a commercial alumina membrane support to improve its structural make up. The coated membrane is further processed under clean room conditions to avoid dust impurity and subsequent drying in an oven for high thermal, chemical and physical stability. The resulting asymmetric membrane exhibits a gradual change in the membrane layer thickness. Compared to a single-layer process using only the membrane support, the dual-layer process improves both flux and selectivity. For the scientifically significant difficulties of natural gas purification, collective CO2, CH4 and H2 gas fluxes and separation factors obtained gave reasonably excellent values. In addition, the membrane selectively separated hydrogen as demonstrated by a high concentration of hydrogen recovery.

Keywords: gas permeation, silica membrane, separation factor, membrane layer thickness

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Authors: Alexandre H. Okano, Pedro M. D. Agrícola, Daniel G. Da S. Machado, Luiz I. Do N. Neto, Luiz F. Farias Junior, Paulo H. D. Nascimento, Rickson C. Mesquita, John F. Araujo, Eduardo B. Fontes, Hassan M. Elsangedy, Shinsuke Shimojo, Li M. Li

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The prefrontal cortex is involved in the reward system and the insular cortex integrates the afferent inputs arriving from the body’ systems and turns into feelings. Therefore, modulating neuronal activity in these regions may change individuals’ perception in a given situation such as exercise. We tested whether transcranial direct current stimulation (tDCS) change cerebral oxygenation and pleasure during exercise. Fourteen volunteer healthy adult men were assessed into five different sessions. First, subjects underwent to a maximum incremental test on a cycle ergometer. Then, subjects were randomly assigned to a transcranial direct current stimulation (2mA for 15 min) intervention in a cross over design in four different conditions: anode and cathode electrodes on T3 and Fp2 targeting the insular cortex, and Fpz and F4 targeting prefrontal cortex, respectively; and their respective sham. These sessions were followed by 30 min of moderate intensity exercise. Brain oxygenation was measured in prefrontal cortex with a near infrared spectroscopy. Perceived exertion and pleasure were also measured during exercise. The asymmetry in prefrontal cortex oxygenation before the stimulation decreased only when it was applied over this region which did not occur after insular cortex or sham stimulation. Furthermore, pleasure was maintained during exercise only after prefrontal cortex stimulation (P > 0.7), while there was a decrease throughout exercise (P < 0.03) during the other conditions. We conclude that tDCS over the prefrontal cortex changes brain oxygenation in ventromedial prefrontal cortex and maintains perceived pleasure during exercise. Therefore, this technique might be used to enhance effective responses related to exercise.

Keywords: affect, brain stimulation, dopamine neuromodulation, pleasure, reward, transcranial direct current stimulation

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Authors: Jingwei Wang, Anthony G. Fane, Jia Wei Chew

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The use of fluidized Granular Activated Carbon (GAC) as a means of mitigation membrane fouling in membrane bioreactors (MBRs) has received much attention in recent years, especially in anaerobic fluidized bed membrane bioreactors (AFMBRs). It has been affirmed that the unsteady-state tangential shear conferred by GAC fluidization on membrane surface suppressed the extent of membrane fouling with energy consumption much lower than that of bubbling (i.e., air sparging). In a previous work, the hydrodynamics of the fluidized GAC particles were correlated with membrane fouling mitigation effectiveness. Results verified that the momentum transfer from particle to membrane held a key in fouling mitigation. The goal of the current work is to understand the effect of fluidized GAC on membrane critical flux. Membrane critical flux values were measured by a vertical Direct Observation Through the Membrane (DOTM) setup. The polystyrene particles (known as latex particles) with the particle size of 5 µm were used as model foulant thus to give the number of the foulant on the membrane surface. Our results shed light on the positive effect of fluidized GAC enhancing the critical membrane flux by an order-of-magnitude as compared to that of liquid shear alone. Membrane fouling mitigation was benefitted by the increasing of power input.

Keywords: membrane fouling mitigation, liquid-solid fluidization, critical flux, energy input

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Authors: Benyamina, Ouldabess, Bensalah

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The aim of this study is to use membrane technique for filtration of a coloring solution. the preparation of the micro-filtration membranes is based on a natural clay powder with a low cost, deposited on macro-porous ceramic supports. The micro-filtration membrane provided a very large permeation flow. Indeed, the filtration effectiveness of membrane was proved by the total discoloration of bromothymol blue solution with initial concentration of 10-3 mg/L after the first minutes.

Keywords: the inorganic membrane, micro-filtration, coloring solution, natural clay powder

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Authors: Hong-Jin Joo, Hee-Yoel Kwak

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Vacuum Membrane Distillation (VMD) uses pressure lower than the atmospheric pressure. The feed seawater is capable of producing more vapor at the same temperature than Direct Contact Membrane Distillation (DCMD), Air Gap Membrane Distillation (AGMD) or Sweep Gas Membrane Distillation (SGMD). It is advantageous because it is operable at a lower temperature than other membrane distillations. However, no commercial product is available that uses the VMD method, as it is still in the study stage. In this study, therefore, thermal performance test according to the feed water conditions was performed prior to both construction of the demonstration plant, which uses VMD module of the capacity of 400m³/d in South Korea, and commercialization of VMD module with hollow fiber membrane. Such study was performed by designing and constructing the VMD module of the capacity of 2 m³/day which utilizes the polyvinylidene fluoride (PVDF) hollow fiber membrane. The results obtained from the VMD module manufactured by ECONITY Co., Ltd in South Korea, showed that the maximum performance ratio (PR) value of 0.904, feed water temperature of 75 ℃, and the flow rate of 8 m3/h. As the temperature of and flow rate of the feed water increased, the PR value of the VMD module also increased.

Keywords: membrane distillation, vacuum membrane distillation, hollow fiber membrane, desalination

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Authors: M. Obaid, Nasser A. M. Barakat, Fadali O.A

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Low stability in oil media and the hydrophobicity problems of the ploysulfone electrospun membranes could be overcome in the present study. Synthesis of super-hydrophilic and highly stable in oil polysulfone electrospun nanofiber membrane was achieved by electrospinning of polysulfone solution containing NaOH salt followed by activation of the dried electrospun membrane by deposition of polyamide layer on the surface using m-phenylenediamine and 1,3,5-benzenetricarbonyl chloride. The introduced membrane has super-hydrophilicity characteristic (contact angle=3o), excellent stability in oil media and distinct performance in oil-water separation process.

Keywords: electrospinning, oil-degradability, membrane, nanofibers

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Authors: Elisa Y. M. Ang, Teng Yong Ng, Jingjie Yeo, Rongming Lin, Zishun Liu, K. R. Geethalakshmi

Abstract:

By stacking carbon nanotubes (CNT) one on top of another, single layer CNT arrays can perform water-salt separation with ultra-high permeability and selectivity. Such outer-wall CNT slit membrane is named as the transverse flow CNT membrane. By adjusting the slit size between neighboring CNTs, the membrane can be configured to sieve out different solutes, right down to the separation of monovalent salt ions from water. Molecular dynamics (MD) simulation results show that the permeability of transverse flow CNT membrane is more than two times that of conventional axial-flow CNT membranes, and orders of magnitude higher than current reverse osmosis membrane. In addition, by carrying out MD simulations with different CNT size, it was observed that the variance in desalination performance with CNT size is small. This insensitivity of the transverse flow CNT membrane’s performance to CNT size is a distinct advantage over axial flow CNT membrane designs. Not only does the membrane operate well under constant pressure desalination operation, but MD simulations further indicate that oscillatory operation can further enhance the membrane’s desalination performance, making it suitable for operation such as electrodialysis reversal. While there are still challenges that need to be overcome, particularly on the physical fabrication of such membrane, it is hope that this versatile membrane design can bring the idea of using low dimensional structures for desalination closer to reality.

Keywords: carbon nanotubes, membrane desalination, transverse flow carbon nanotube membrane, molecular dynamics

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Authors: Adnan Alhathal Alanezi, Alanood A. Alsarayreh

Abstract:

A direct contact membrane distillation (DCMD) system was modeled using various angles for the membrane unit and a Reynolds number range of 500 to 2000 in this numerical analysis. The Navier-Stokes, energy, and species transport equations were used to create a two-dimensional model. The finite volume method was used to solve the governing equations (FVM). The results showed that as the Reynolds number grows up to 1500, the heat transfer coefficient increases for all membrane angles except the 60ᵒ inclination angle. Additionally, increasing the membrane angle to 90ᵒreduces the exit influence while increasing heat transfer. According to these data, a membrane with a 90o inclination angle (also known as a vertical membrane) and a Reynolds number of 2000 might have the smallest temperature differential. Similarly, decreasing the inclination angle of the membrane keeps the temperature difference constant between Reynolds numbers 1000 and 2000; however, between Reynolds numbers 500 and 1000, the temperature difference decreases dramatically.

Keywords: direct contact membrane distillation, membrane inclination angle, heat and mass transfer, reynolds number

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Authors: Lopez J., Mehrvar M., Quinones E., Suarez A., Romero C.

Abstract:

Membrane Distillation is an emerging technology that uses thermal and membrane steps for the desalination process to get drinking water. In this study, silver nanoparticles (AgNP) were deposited by dip-coating process over Polyvinylidene Fluoride, Fiberglass hydrophilic, and Polytetrafluoroethylene hydrophobic commercial membranes as substrate. Membranes were characterized and used in a Vacuum Membrane Distillation cell under Ultraviolet light with sea salt feed solution. The presence of AgNP increases the absorption of energy on the membrane, which improves the transmembrane flux.

Keywords: silver nanoparticles, membrane distillation, desalination technologies, heat deliver

Procedia PDF Downloads 134

Authors: M. I. Aida Isma, Azni Idris, Rozita Omar, A. R. Putri Razreena

Abstract:

40L of hollow fiber membrane bioreactor with solids retention times (SRT) of 30, 15 and 4 days were setup for treating synthetic wastewater at hydraulic retention times (HRT) of 12, 8 and 4 hours. The objectives of the study were to investigate the effects of SRT and HRT on membrane fouling. A comparative analysis was carried out for physiochemical quality parameters (turbidity, suspended solids, COD, NH3-N and PO43-). Scanning electron microscopy (SEM), energy diffusive X-ray (EDX) analyzer and particle size distribution (PSD) were used to characterize the membrane fouling properties. The influence of SRT on the quality of effluent, activated sludge quality, and membrane fouling were also correlated. Lower membrane fouling and slower rise in trans-membrane pressure (TMP) were noticed at the longest SRT and HRT of 30d and 12h, respectively. Increasing SRT results in noticeable reduction of dissolved organic matters. The best removal efficiencies of COD, TSS, NH3-N and PO43- were 93%, 98%, 80% and 30% respectively. The high HRT with shorter SRT induced faster fouling rate. The main fouling resistance was cake layer. The most severe membrane fouling was observed at SRT and HRT of 4 and 12, respectively with thickness cake layer of 17 μm as reflected by higher TMP, lower effluent removal and thick sludge cake layer.

Keywords: membrane bioreactor, SRT, HRT, fouling

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Authors: Rizwan Ahmad, Soomin Chang, Daeun Kwon, Jeonghwan Kim

Abstract:

Interests in an inorganic membrane are growing rapidly for industrial wastewater treatment due to its excellent chemical and thermal stability over polymeric membrane. Nevertheless, understanding of the membrane rejection and fouling rate caused by the deposit of contaminants on membrane surface and within membrane pores through inorganic porous membranes still requires much attention. Microfiltration alumina membranes were developed and applied for the industrial wastewater treatment to investigate rejection efficiency of organic contaminant and membrane fouling at various operational conditions. In this study, organic rejection and membrane fouling were investigated by using the alumina flat-tubular membrane developed for the treatment of industrial wastewaters. The flat-tubular alumina membranes were immersed in a fluidized membrane reactor added with granular activated carbon (GAC) particles. Fluidization was driven by recirculating a bulk industrial wastewater along membrane surface through the reactor. In the absence of GAC particles, for hazardous anionic dye contaminants, functional group characterized by the organic contaminant was found as one of the main factors affecting both membrane rejection and fouling rate. More fouling on the membrane surface led to the existence of dipolar characterizations and this was more pronounced at lower solution pH, thereby improving membrane rejection accordingly. Similar result was observed with a real metal-plating wastewater. Strong correlation was found that higher fouling rate resulted in higher organic rejection efficiency. Hydrophilicity exhibited by alumina membrane improved the organic rejection efficiency of the membrane due to the formation of hydrophilic fouling layer deposited on it. In addition, less surface roughness of alumina membrane resulted in less fouling rate. Regardless of the operational conditions applied in this study, fluidizing the GAC particles along the surface of alumina membrane was very effective to enhance organic removal efficiency higher than 95% and provide an excellent tool to reduce membrane fouling. Less than 0.1 bar as suction pressure was maintained with the alumina membrane at 25 L/m²hr of permeate set-point flux during the whole operational periods without performing any backwashing and chemical enhanced cleaning for the membrane.

Keywords: alumina membrane, fluidized membrane reactor, industrial wastewater, membrane fouling, rejection

Procedia PDF Downloads 135

Authors: M. Heidari, A. Safekordi, A. Zamaniyan, E. Ganji Babakhani, M. Amanipour

Abstract:

Perovskite-type membrane Ba_0.5Sr_0.5Ce_0.9Y_0.1O_3-δ (BSCY) was successfully synthesized by liquid citrate method. The hydrogen permeation and stability of BSCY perovskite-type membranes were studied at high temperatures. The phase structure of the powder was characterized by X-ray diffraction (XRD). Scanning electron microscopy (SEM) was used to characterize microstructures of the membrane sintered under various conditions. SEM results showed that increasing in sintering temperature, formed dense membrane with clear grains. XRD results for BSCY membrane that sintered in 1150 °C indicated single phase perovskite structure with orthorhombic configuration, and SEM results showed dense structure with clear grain size which is suitable for permeation tests. Partial substitution of Sr with Ba in SCY structure improved the hydrogen permeation flux through the membrane due to the larger ionic radius of Ba²⁺. BSCY membrane shows high hydrogen permeation flux of 1.6 ml/min.cm² at 900 °C and partial pressure of 0.6.

Keywords: hydrogen separation, perovskite, proton conducting membrane.

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Authors: N. Hasbullah, K. A. Sekak

Abstract:

The sulfonated poly (ether ether ketone) SPEEK nanofiber membrane were successfully electrospun for Polymer Electrolyte Membrane (PEM) in Proton Exchange Membrane Fuel Cell (PEMFC) and their nanosized properties were investigated. The poly (ether ether ketone) PEEK victrex® grade 90p was sulfonated with concentrated sulfuric acid (95-98% w/w) at room temperature for 60 hours sulfonation times. The degree sulfonation of SPEEK are 70% was determined by H1 NMR and the functional groups of the SPEEK were characterize using FTIR. Then, the SPEEK nanofiber membrane were prepared via electrospinning method using DMAC as a solvent. The SPEEK sample were successfully electrospun using predetermine set up. FESEM show the electrospun fiber mat surface and confirmed the nanostructure membrane cell.

Keywords: polymer electrolyte membrane (PEM), sulfonated poly (ether ether ketone) (SPEEK), degree sulfonation, Electrospinning, Nanofibers

Procedia PDF Downloads 278

Authors: Kai-Wei Huang, Yi-Feng Lin

Abstract:

The purpose of this study is to have chemical resistance, high heat resistance and mechanical strength of ceramic hollow fiber membrane into a membrane contactor, and the combustion process is applied (Post-combustion capture) of the carbon dioxide absorption device. In this paper, we would investigate the effect of the ceramic membrane hydrophobicity to the flux of the carbon dioxide adsorption. To improve the applicability of the ceramic film. We use the dry-wet spinning method with the high temperature sintering process for preparing a ceramic hollow fiber membranes to increase the filling density per unit volume of the membrane. The PESf/Al2O3 ratio of 1:5 was prepared ceramic hollow fibers membrane precursors and investigate the relationship of the different sintering temperature to the membrane pore size and porosity. It can be found that the membrane via the sintering temperature of 1400 °C prepared with the highest porosity of 70%, while the membrane via the sintering temperature of 1600 °C prepared although has a minimum porosity of about 54%, but also has the smallest average pore size of about 0.2 μm. The hydrophilic ceramic hollow fiber membranes which after high-temperature sintering were changed into hydrophobic successfully via the 0.02M FAS modifier. The hydrophobic ceramic hollow fiber membranes with different sintering temperature, the membrane which was prepared via 1400 °C sintering has the highest carbon dioxide adsorption about 4.2 × 10-4 (mole/m2s). The membrane prepared via 1500 °C sintering has the carbon dioxide adsorption about 3.8 × 10-3 (mole/m2s),and the membrane prepared via 1600 °C sintering has the lowest carbon dioxide adsorption about 2.68 × 10-3 (mole/m2s).All of them have reusability and in long time operation, the membrane which was prepared via 1600 °C sintering has the smallest pores and also could operate for three days. After the test, the 1600 °C sintering ceramic hollow fiber membrane was most suitable for the factory.

Keywords: carbon dioxide capture, membrane contactor, ceramic membrane, ceramic hollow fiber membrane

Procedia PDF Downloads 318

Authors: Ortega Ivan, De La Plaza Edurne

Abstract:

Background: Spain and other European countries have implemented Uncontrolled Donation after Cardiac Death (uDCD) programs. After 15 years of experience in Spain, many things have changed. Recent evidence and technical breakthroughs achieved in resuscitation are relevant for uDCD programs and raise some ethical concerns related to these protocols. Aim: To rethink current uDCD programs in the light of recent evidence on available therapeutic procedures applicable to victims of out-of-hospital cardiac arrest (OHCA). To address the following question: What is the current standard of treatment owed to victims of OHCA before including them in an uDCD protocol? Materials and Methods: Review of the scientific and ethical literature related to both uDCD programs and innovative resuscitation techniques. Results: 1) The standard of treatment received and the chances of survival of victims of OHCA depend on whether they are classified as Non-Heart Beating Patients (NHBP) or Non-Heart-Beating-Donors (NHBD). 2) Recent studies suggest that NHBPs are likely to survive, with good quality of life, if one or more of the following interventions are performed while ongoing CPR -guided by suspected or known cause of OHCA- is maintained: a) direct access to a Cath Lab-H24 or/and to extra-corporeal life support (ECLS); b) transfer in induced hypothermia from the Emergency Medical Service (EMS) to the ICU; c) thrombolysis treatment; d) mobile extra-corporeal membrane oxygenation (mini ECMO) instituted as a bridge to ICU ECLS devices. 3) Victims of OHCA who cannot benefit from any of these therapies should be considered as NHBDs. Conclusion: Current uDCD protocols do not take into account recent improvements in resuscitation and need to be adapted. Operational criteria to distinguish NHBDs from NHBP should seek a balance between the technical imperative (to do whatever is possible), considerations about expected survival with quality of life, and distributive justice (costs/benefits). Uncontrolled DCD protocols can be performed in a way that does not hamper the legitimate interests of patients, potential organ donors, their families, the organ recipients, and the health professionals involved in these processes. Families of NHBDs’ should receive information which conforms to the ethical principles of respect of autonomy and transparency.

Keywords: uncontrolled donation after cardiac death resuscitation, refractory cardiac arrest, out of hospital cardiac, arrest ethics

Procedia PDF Downloads 207