ABYLCAP CARBON DIOXIDE REMOVAL ECCO 2 R
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Transcript of ABYLCAP CARBON DIOXIDE REMOVAL ECCO 2 R
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ABYLCAP CARBON DIOXIDE REMOVALECCO2R
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TREATMENTS FOR CO2 REMOVAL
WHY ?
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During the use of mechanical ventilation with low tidal volume, the exceeding CO2 arising from this “protective” technique is to
be removed to avoid Acidosis .
Low tidal volume High tidal volume
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ARF (Acute Respiratory Failure)
It’s an alteration in alveolar ventilation and / or a difficulty in pulmonary gas exchange, which can be determined by insufficient transport of oxygen to the tissues or by insufficient utilization of oxygen by peripheral tissues
ARDS (Acute Respiratory Distress Syndrome)ARDS is a severe acute respiratory failure resulting from pulmonary edema caused by increased permeability of the alveolar capillary barrier.
ARDS is a specific lung disease, it is rather a severe pulmonary dysfunction due to underlying lung disease (sepsis, trauma, pneumonia).
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Heart
Kidney
Brain
CO2 spreads from tissues and is moved to the alveolar capillaries in 3 different ways:
• from about 3 to 5% in a physically diluted form (solubility 0,00069 mL/mL/mmHg)
• from about 7 to 10% bound to the Hb through a carbaminic bind (carbo-hemoglobin)
• More than 80% “interacts” in the red blood cell to turn into HCO3
- in the plasmatic water
How is CO2 distributed?
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Cl-
Tissues 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-
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Spreading from the tissues into the red blood cells, the CO2 catalyzes the hydration reaction through carbonic anhydrase: CO2 + H20 -> H2CO3
• Then it dissociates: H2CO3 -> H+ + HCO3-
• The hydrogen ion (H+) is buffered by the Hb, the bicarbonate ion (HCO3
- ) moves from the red blood cell into plasma through a carrier protein of the erythrocyte membrane, simultaneously an exchange takes place with a chloride ion (Cl-)
How does CO2 move “through” the red blood cells?
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Lung Plasma Red Blood Cell
Capillary 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
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The adverse reaction arises when the blood oxygenation causes an increase in the acidity of Hb and it involves the following: • A decrease in the buffer capacity with a release of
ions H+ • Hence: H+ + HCO3
- -> H2CO3 -> H20 + CO2. • And the CO2 in excess is released
How is CO2 expelled ?
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A decrease in the strength of the carbaminic binds between Hb and CO2 allows the release of CO2 by 7-10% transferred in the form of carbo-hemoglobin
• Inside capillaries the effect leads to a higher intake of CO2 in blood because O2 is released from Hb
• Inside pulmonary alveoli the effect leads to a higher output of CO2 from blood due to the fact that the Hb binds with O2
How is CO2 expelled ?
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The inclination of the solubility curve between 40 and 45 mmHg is 0,0045 (mL/mL)/mmHg
Less than half of CO2 released in lungs is due to the 5 mmHg excursion down the venous dissociation curve.
The release of the remaining CO2 occurs due to the downwards shift of the dissociation curve, meaning the Haldane effect occurring when the pO2 changes from 40 mmHg (75% of O2 saturation) to 100 mmHg (100% O2 saturation)
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The total quantity of CO2 in blood is proportional to its partial pressure
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The factors that shift the dissociation curve of Hb
With the same value of pO2 we have greater or lesser percentage of saturation of Hb
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The factors that shift the dissociation curve of Hb
With the same value of pO2 we have greater or lesser percentage of saturation of Hb
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That’s why Abylcap was created for Lynda
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Ossigenator
CO2
O2
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Characteristics
The kit is made up of:• 2 couples of Lines for extracorporeal circulation• 2 heating Lines• 1 Lilliput ECMO 2 Oxygenator• Connectors
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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 2300 ml/min• 5 days duration• ETO Sterilization
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Non thrombogenic surfaces: PHISIO COATING
COATINGCOATING
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ECMO CPBDuration
Characteristics of materials
ECMO Vs CPB
More than 21 days Maximum 3,5 h
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Polypropylene “standard“ membrane
Polymethylpentene “plasma-tight“ membrane
Fibres in Polypropylene: gas comes into contact with blood through microporous
fibres. The gas transfer is obtained
through direct contact.
Fibres in Polypropylene: gas comes into contact with blood through microporous
fibres. The gas transfer is obtained
through direct contact.
Fibres in Polymethylpentene: the hollow fibres are protected
by an external thin membrane. Gas transfer is
obtained by diffusion.
Fibres in Polymethylpentene: the hollow fibres are protected
by an external thin membrane. Gas transfer is
obtained by diffusion.
Plasma-tight membrane: POLYMETHYLPENTENE
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Polymethylpentene “plasma-tight“ fibre
Polypropylene “standard“ fibre
OUTER SURFACE
Plasma-tight membrane: POLYMETHYLPENTENE
Main technical characteristics:
Gas transferred by diffusion (no direct contact blood gas)
No plasma-breakthrough (>120h, according to Dideco test
procedures)
Gas exchange capacity compared to other hollow fibers that
work in direct contact (for the protection of the external
surface 1 mm)
Suitable for long-lasting use
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Siggaard-Andersen
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Siggaard-Andersen
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1) resorption of HCO3-
2) regeneration of HCO3-.
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Lynda is the first example of multidisciplinary approach
Continuous Treatments for Renal Failure
Intermittent Treatments for Renal Failure
CPFA Treatment for patients with severe sepsis, septic shock or MOF
Therapeutic Plasma Exchange Treatments
APPLICATION IN INTENSIVE CARE
Treatments for CO2 Removal
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CONCLUSIONS
Thanks to Lynda, Bellco can propose to the I.C. Units a “multi-organ support therapy” by integrating in one single
device a support for:ECCO2R Ventilation, TPE Plasma exchange , CVVH, CVVHD,
CVVHDF Acute Renal Failure and CPFA Sepsis.
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