Bellco srl

Lynda CRRT machineCVVH PEX & CPFA

Presentation

Versatile for the physician, functional for the nurse, effective for the Versatile for the physician, functional for the nurse, effective for the patientpatient.

A simple answer to complex questions from the Abyle line

Therapeutic versatility – Wide range of options

Technological innovation, the wide range of therapies and ease of use are the essential features of Lynda

– Wide range of options– Continual monitoring of hematocrit and oxygen Continual monitoring of hematocrit and oxygen

saturationsaturation

The HCT (with blood volume calculation) and the SO2 can directly and continuously be measured through a high-precision instrument (closed system with cuvette integrated in the arterial line).

A sensor measures a physical quantity. An application interprets the measurement A sensor measures a physical quantity. An application interprets the measurement

and gives it a clinical meaningand gives it a clinical meaning

Therapeutic versatility

– Program the infusion system inProgram the infusion system in

pre-dilution, post-dilution, pre-dilution, post-dilution,

or pre-post dilution simultaneouslyor pre-post dilution simultaneously

Therapeutic versatility – Wide range of options

– Continual monitoring of Continual monitoring of hematocrit and hematocrit and oxygen oxygen saturationsaturation

Therapeutic versatility – Wide range of options

– Continual monitoring of hematocrit and Continual monitoring of hematocrit and oxygen oxygen saturationsaturation

– Program the infusion system in pre-dilution, post-dilution, or pre-post dilution simultaneously

– Filtration fraction control (ff).Filtration fraction control (ff).

Therapeutic versatility

– Wide range of options

– Continual monitoring of hematocrit and Continual monitoring of hematocrit and oxygen oxygen saturationsaturation– Program the infusion system in pre-dilution,

post-dilution, or pre-post dilution simultaneously– Filtration fraction control (ff).– History file (over 300 hours capacity).History file (over 300 hours capacity).

The most important information on the therapies performed, the clinical parameter settings, the pressure and infused fluid volume graphs

Functionality

  Automatic priming Automatic priming in all treatment methodsin all treatment methods.

Functionality

  Automatic priming in all treatment methods.

  On-line guide for the operator to check all the On-line guide for the operator to check all the sequences sequences ““instant by instantinstant by instant”.

Functionality

  Automatic priming in all treatment methods.  On-line guide for the operator to check all the

sequences “instant by instant”.

• High-visibility display with user-friendly High-visibility display with user-friendly and intuitive touch screen interface, and intuitive touch screen interface, which allows clear, fast and which allows clear, fast and direct dialogue direct dialogue with the machine.with the machine.

Functionality  Automatic priming in all treatment methods.  On-line guide for the operator to check all the

sequences “instant by instant”.

• High-visibility display with user-friendly and intuitive touch screen interface, which allows clear, fast and direct dialogue with the machine.

• Autonomy of 40 litres of controlled exchange Autonomy of 40 litres of controlled exchange between two scales, saving time and reducing between two scales, saving time and reducing the possibility of error the possibility of error

Bicompartmental bag:

The bag is composed of two separate compartments: one for the bicarbonate buffer (5000 mL) and the other for the electrolytes (500 mL). The contents are mixed just before use.

Two simple operations allow obtaining a solution that remains stable up to 24 hours:

- Breakage of the septum separating the two compartments

- Brief agitation to encourage mixing and obtain a homogeneous solution.

EffectivenessEffectiveness

EffectivenessEffectiveness• The disposable Plug & Play The disposable Plug & Play

system, system, comprising preconnected filter/s comprising preconnected filter/s and lines for all the treatment and lines for all the treatment methods, simplifies and speeds methods, simplifies and speeds up the installation operations up the installation operations and reduces the possibility of and reduces the possibility of error.error.

Uf

EMOFILTRO

SCUF(SLOW CONTINUOUS ULTRAFILTRATION)

Post diluizione (20:100%)

Uf

Infusione o anticoagulante

EMOFILTRO

CVVH, IHF-HVHF(CONTINUOUS VENO-VENOUS

HEMOFILTRATION, INTERMITTENT HEMO FILTRATION – HIGH VOLUME

HEMOFILTRATION, SINGLE NEEDLE HEMOFILTRATION)

Pre diluizione

(0:80%)

Uf

EMOFILTRO

SN HF(SINGLE NEEDLE HEMOFILTRATION)

Infusione o anticoagulante

Post diluizione

Plasma

PEXPEX(PLASMA EXCHANGE)(PLASMA EXCHANGE)

PLASMAFILTRO

Liquido di sostituzione

anticoagulante

CPFACPFA

p

p

p

p

p

p

p

• Disposable Plug & Play• CPFACPFA: a targeted response to sepsis

EffectivenessEffectiveness

What is Sepsis ?ACCP/SCCM Consensus Definitions

• Infection– Inflammatory response to

microorganisms, or– Invasion of normally sterile tissues

• Systemic Inflammatory Response Syndrome (SIRS)

– Systemic response to a variety of processes

• Sepsis– Infection plus 2 SIRS criteria

• Severe Sepsis– Sepsis– Organ dysfunction

• Septic shock– Sepsis– Hypotension despite fluid

resuscitation

• Multiple Organ Dysfunction Syndrome (MODS)

– Altered organ function in an acutely ill patient

– Homeostasis cannot be maintained without intervention

Bone RC et al. Chest. 1992;101:1644-55.

Infection

Systemic inflammatory

response

Multi-organ dysfunction

Eliminate infectionantibiotics

Reduce systemic reaction

SteroidsInsulin (glucose control)Xigris

Support organsVentilationCRRT

Therapeutic Strategies

IV fluidsVasopressors

Endothelial Dysfunction

Cell activation

Coupled Plasma Filtration Adsorption

Plasma

reinfusion in

UF out

Therapeutic goalSeparate and retain “toxins”

from a complex mixture

Time = 0 later

“toxins”

Physiological“good” molecules

Ideal therapy for sepsis

Plasma

Dialysate in

Dialysate out

“bad molecules”

“good molecules”

What can the CPFA resin adsorb?

• Interleukin 1

• Interleukin 5

• Interleukin 6

• Interleukin 7

• Interleukin 8

• Interleukin 10(?)

• Interleukin 12p70

• Interleukin 16

• Interleukin 18

• Macrophage inflammatory protein- (MIP-)

• Macrophage inflammatory protein- (MIP-

• Tumor necrosis factor-TNF-• Monocyte chemotactic protein (MCP-1)

• RANTES

• Epithelial neutrophil activating peptide 78 (ENA-78)

• Angiogenin

CPFA used successfully in non-ARF patients

Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock

Marco Formica, Carlo Olivieri, Sergio Livigni, Giulio Cesano, Antonella Vallero, Mariella Maio and Ciro Tetta

Intensive Care Med (2003) 29: 703-708

Objective: The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs).

Conclusion: Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.

What is not adsorbed to the resin

No significant adsorption of• Albumin

• Heparin

• Citrate

• Antibodies

• Ferritin

• GM-CSF

• Thyroxine

• Adiponectin

• Von Willebrand factor

• Endotoxin

Low Adsorption• Insulin (1st hour)

• VEGF

• EGF

• ICAM

• VCAM

• MCP