Administration and monitoring of nitric oxide in ex vivo fluids
Described are systems and methods for monitoring administration of nitric oxide (NO) to ex vivo fluids. Examples of such fluids include blood in extracorporeal membrane oxygenation (ECMO) circuits or perfusion fluids used for preserving ex vivo organs prior to transplanting in a recipient. The systems and methods described herein provide for administering nitric oxide to the fluid, monitoring nitric oxide or a nitric oxide marker in the fluid, and adjusting the nitric oxide administration.
1. A system for delivering and monitoring nitric oxide (NO) to an ex vivo lung, comprising:
a container operable for storing the lung and filled with a perfusion fluid for perfusing the lung;
a NO delivery device operable to administer NO to the perfusion fluid; and
a monitoring device operable to monitor methemoglobin in the perfusion fluid,
wherein the monitoring device is in communication with the NO delivery device, and the NO delivery device is operable to adjust the NO administration based on the monitoring of the methemoglobin.
2. The system of claim 1 , wherein the monitoring device is a separate component from the NO delivery device.
3. The system of claim 1 , wherein the monitoring device is integrated with the NO delivery device.
4. The system of claim 3 , wherein the monitoring device is further operable to monitor at least one additional parameter of the perfusion fluid selected from at least one of NO, a NO marker, and an indicator of tissue damage.
5. The system of claim 1 , wherein the perfusion fluid includes NO or an NO donor.
6. The system of claim 5 , wherein the monitoring device is further operable to monitor at least one additional parameter of the perfusion fluid including at least one of NO, a NO marker and an indicator of tissue damage.
7. The system of claim 6 , wherein the NO delivery device is further operable to adjust the amount of NO or NO donor provided to the lung according to the methemoglobin and the additional parameter monitored.
8. The system of claim 5 , wherein the monitoring device is further operable to monitoring at least one secondary parameter including at least one of pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP) and mean pulmonary arterial pressure (mPAP).
9. The system of claim 8 , wherein the NO delivery device is further operable to adjust the amount of NO or NO donor provided to the lung according to the monitored secondary parameter.
10. The system of claim 1 , further comprising a catheter operable to be connected to the lung, the catheter operable to inject a persufflation gas into the lung.
11. The system of claim 10 wherein the system is operable to perfuse and persufflate the lung simultaneously.
12. The system of claim 10 , wherein the perfusion fluid has a first composition and the container is filled with a preservation fluid having a second composition used to store the lung during persufflation.
13. The system of claim 1 , further comprising a ventilator operable to ventilate the lung.
14. The system of claim 13 , wherein the system is operable to perfuse and ventilate the lung simultaneously.
15. The system of claim 1 , wherein the perfusion fluid includes red blood cells.
16. The system of claim 1 , wherein the perfusion fluid includes at least one of a histidine-tryptophan-ketoglutarate solution and a colloid-containing, extracellular-type low K+ electrolyte solution.
17. The system of claim 1 , wherein the monitoring device is operable to monitor methemoglobin in the perfusion fluid continuously.