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Higher Flow Rates Improve Heating During Hyperthermic Intraperitoneal Chemoperfusion
*Matthew J Furman, *Mark J Wante, *Robert J Picotte, *Barur R Rajeshkumar, Giles F Whalen, *Laura A Lambert
University of Massachusetts Medical Center, Worcester, MA
Objective: To determine if higher heated intraperitoneal chemotherapy (HIPEC) flow rates improves heating of the peritoneum.
Design: 43°C water was circulated at varying flow rates through a HIPEC model (30.8L cooler, extracorporeal pump, 26L of 37°C water (WB), 1L saline bag (SB) in a cooling sleeve). Time to goal temperature with and without the cooling sleeve heat sink (HS) were measured. Using a swine HIPEC model, time to goal outflow and peritoneal tempertaure and the minimum flow rate required to reach 43°C during HIPEC were recorded. The impact of flow rate on peritoneal heating during 20 clinical HIPECs was also reviewed.
Setting: Basic Science/Animal Lab.
Patients: See Design.
Intervention: Flow Rate.
Main Outcome Measure: Time to goal Temperature.
Results: Higher flow rates decreased the time for the (WB) and (SB) to reach 43°C (Table). With a HS, minimum flow rate for WB to reach 43°C was 1.75L/min. Temperature differences between the WB and SB were greater at higher flow rates. In the swine, 18 minutes were required to reach an outflow temperature of 43°C at 4L/min. As flow rate decreased from 4 to 0.5L/min, the outflow temperature decreased from 43°C to 40.4°C. Minimum flow rate to reach 43°C outflow temperature was 3.0L/min. Analysis of 20 clinical HIPECs showed that increased flow leads to higher intraperitoneal temperatures in less time.
Conclusions: Increased flow during HIPEC leads to better heating of the peritoneal cavity and affords greater temperature differences between peritoneum and viscera. HIPEC flow rates should be maximized.
|Flow rate |
|Time for WB|
to reach 43C
|Temperature difference between WB and SB when WB reached 43C without heat sink|
|Time for WB to reach 43C with heat sink|
NR: Not Reached
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August 13, 2014
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August 11, 2014