Lynda and “Abyle” products

Blood pump

Moves blood in all the therapies.

• In CRRT the blood flow is between 0.30 and 450 ml/min.

• In CPFA and PEX the blood flow ranges from 0.30 to 250 ml/min.

Ultrafiltration Pump

Moves the ultrafiltration fluid, ranging from 0.5 to 12 lt/h.

Variable- Wanted weight loss

Reached weight loss

Plasma Pump

It moves Pre-dilution infusion, range 0 -9.6 Lt/h, in CVVH/ IHF and Post-dilution infusion, range 0 - 4 Lt/h, in CVVHD/CVVHDF/IHD/IHDF.

In CPFA the plasma flows in a range from 0.5 to 25 % of blood’s flow

Infusion Pump

In CVVH/ IHF/ CPFA - moves post-dilution infusion.In CVVHD/ CVVHDF/ IHD/ IHDF - moves dialysate.In PEX - moves substitution fluid.

Flow ranges from 0-12 Lt/h

Allows control over the precent of pre to post dilution infusion (green to blue pump flow).

Citrate pump

This pump delivers citrate into the blood line.

7 Pressure Transducers

7 pressure transducers checkdifferent pressures:• arterial - from - 300 to +30 mmHg• venous - from -30 to +300 mmHg• prefilter - from 0 to +400 mmHg• transmembrane (TMP) - from -300 to +400 mmHg• plasma output• cartridge output• cartridge input

Blood Leak Detector

Optic detector with 2 sensors, can show a blood leak on the filtrate line.

Air detector and clamp

An ultrasonic sensor reports the presence of air bubbles if bigger than 50 µl. This sensor is connected with a clamp to stop the venous blood flow in case of alarm.

Syringe PumpA pump for administration of continuous (0-10 ml/h) or bolus (0-20 ml) of anticoagulant or Ca2+.

The pump can accept syringes of all types with a variable volume between 20 to 60 ml.

HCT and SO2 Meter

The Hematocrit (with blood volume calculation) and the Saturation are measured continuously through a high-precision instrument from the arterial line. There is also the possibility of checking the hemo-concentration through the direct measure of HCT.

Infusion Scale

It controls the infusion-dialysate fluid.

It can hold up to 40 liters exchange.

Ultrafiltration Scale

It controls the ultrafiltrate fluid.

It can hold up to 40 liters exchange.

Heater

It allows to heat the infusion fluidin pre or post dilution. The temperature canbe set between 30°

C and 40°

C with stepsof 0.1°

C.

Display touch screen

A high-visibility display with user friendly and intuitive touch-screen interface. Allows clear, fast and direct dialogue with the machine. It shows colors and a clear graphic line with its 10.5 inches.

Display

The screen is divided into 4 areas in which information appear.

Title area : name of active window and treatment.

Active window :displays information and

allows the user to set all data.

On line guide

Function keys : they are used toactivate different functions.

Placement Kit disposable

Treatment Options

SCUF(SLOW CONTINUOUS ULTRAFILTRATION)

Uf

EMOFILTRO

CVVH, IHF-HVHF(CONTINUOUS VENO-VENOUS HEMOFILTRATION/ INTERMITTENT HEMO FILTRATION – HIGH VOLUME HEMOFILTRATION)

Uf

CVVHD/ IHD-SLED(CONTINUOUS VENO-VENOUS HEMODIALYSIS / INTERMITTENT HEMODIALYSIS SLOW EXTENDED DIALYSIS)

Uf

CVVHDF/ IHDF(CONTINUOUS VENO-VENOUS HEMODIAFILTRATION / INTERMITTENT HEMODIAFILTRATION)

Uf

PEX(PLASMA EXCHANGE)Liquido di

sostituzionePost diluizione

Plasma

PLASMAFILTRO

Thanks to a laminar flow, formed elements of blood are repelled by the electronegative membrane. Thus the activation and / or platelet dispersion is much more limited and erythrocytes survival is significantly unaffected.

CPFA(COUPLED PLASMA FILTRATION ADSORPTION)

anticoagulante

Extracorporeal CO2 Removal

(ECCO2R)

Veno-Venous-

Oxygenation (↑O2) + Ventilation (↓CO2)

Tissue Plasma

Red blood cell

Capillary w

all

CO2

O2 O2

HCO3-

Cl-

Na+

H2O

CO2 + H2O ca H2CO3

HCO3- H+

K+

H2O

O2

}Hb

}HHb

HbO2

CO2

O2

CO2

3-5%

85-90%

7-10%

CO2

Cl-

Alveolar w

all

CO2

O2 O2

HCO3-

Cl-

Na+

H2O

CO2

CO2 + H2O ca H2CO3

HCO3- H+

K+

H2O

O2

}Hb

}HHb

HbO2

CO2

O2

Cl-

CO2

Lung Plasma

Red blood cell

VILI – Ventilator Induced Lung Injury

VAP – Ventilator associated pneumonia

Barotrauma – Pneomothorax

Volutrauma - Overdistention induced permeability

edema

Atelectrauma - Shear injury induced by repeated

airway opening/closing

Biotrauma - Inflamatory reaction in the lung

Dreyfuss et al. Am Rev Resp Dis 1985, 132: 880-884

Dreyfuss et al. Am Rev Resp Dis 1985, 132: 880-884

Tremblay et al. J Clin Invest 1997, 99:944-952.

MV- Moderate VolumeHV- High Volume

HP- High PEEPZP- Zero PEEP

Oxygenation (↑O2) + Ventilation (↓CO2)

Tidal Volume (TV)

Frequency (F)

% O2 (FIO2)

Pressure (P)

A “protective” technique (low TV) for avoiding VILI causes exceeding CO2 levels that should be removed to avoid

Acidosis .

(Veno-venous) ECCO2R(Venovenous Extracorporeal CO2 Removal)

CO2

ECMO CPBDuration

Up to 4 days

ECMO Vs CPB

21 days Several hours

FAQ1. Does ECCO2R oxygenate the blood?

Answer: Yes, but not enough to oxygenate the patient.

2. How long is the treatment?

Answer: A single kit can be used for up to 4 days, after 48 hours replacing the tubing (not the oxygenator) is needed!

3. Can we perform ECCO2R and CRRT at the same time?

Answer: Bellco is still working on it.

PO2 8mm/Hg PO2 650mm/Hg

ECCO2R:ECMO: 6000 ml/min

450 ml/min

Main characteristics

Lilliput ECMO2 Oxygenator

Polymethylpentene membrane

Membrane surface 0,67 m2

Heater surface 0,02 m2

Filling volume 90 ml Connections 1/4”- 5/16” Maximum flow 450 ml/min 4 days duration ETO Sterilization

Non thrombogenic surfaces: PHISIO COATING

COATINGCOATING

Polypropylene “standard“ membrane

Polymethylpentene “plasma-tight“ membrane

gas comes into contact with blood

through microporous fibres.

gas transfer is obtained through direct contact.

gas comes into contact with blood

through microporous fibres.

gas transfer is obtained through direct contact.

The hollow fibres are protected by an

external thin membrane. Gas

transfer is obtained by diffusion.

The hollow fibres are protected by an

external thin membrane. Gas

transfer is obtained by diffusion.

Plasma-tight membrane: POLYMETHYLPENTENE

Anticoagulation: Heparin or Citrate ???

To avoid Hypernatremia use Heparin – 10-15 Iu/kg/h

(Citrate)

Continuous Treatments for Renal Failure

Intermittent Treatments for Renal Failure

Therapeutic Plasma Exchange Treatments

CPFA Treatment for patients with severe sepsis, septic shock or MOF

Treatment for CO2 Removal

LYNDA – A MULTIDISCIPLINARY APPROACH

Thank you!

QUESTIONS?