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ABYLCAP CARBON DIOXIDE REMOVAL ECCO 2 R. TREATMENTS FOR CO 2 REMOVAL WHY ?

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Presentation on theme: "ABYLCAP CARBON DIOXIDE REMOVAL ECCO 2 R. TREATMENTS FOR CO 2 REMOVAL WHY ?"— Presentation transcript:

1 ABYLCAP CARBON DIOXIDE REMOVAL ECCO 2 R

2 TREATMENTS FOR CO 2 REMOVAL WHY ?

3 During the use of mechanical ventilation with low tidal volume, the exceeding CO 2 arising from this “protective” technique is to be removed to avoid Acidosis. Low tidal volume High tidal volume

4 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).

5 Heart Kidney Brain CO 2 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 HCO 3 - in the plasmatic water How is CO 2 distributed?

6 Cl - TissuesPlasmaRed blood cell Capillary wall CO 2 O2O2 O2O2 HCO 3 - Cl - Na + H2OH2O CO 2 + H 2 O ca H 2 CO 3 HCO 3 - H + K+K+ H2OH2O O2O2 } Hb } HHb HbO 2 CO 2 O2O2 3-5% 85-90% 7-10% CO 2 Cl -

7 Spreading from the tissues into the red blood cells, the CO 2 catalyzes the hydration reaction through carbonic anhydrase: CO 2 + H 2 0 -> H 2 CO 3 Then it dissociates: H 2 CO 3 -> H + + HCO 3 - The hydrogen ion (H + ) is buffered by the Hb, the bicarbonate ion (HCO 3 - ) 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 CO 2 move “through” the red blood cells?

8 LungPlasmaRed Blood Cell Capillary wall CO 2 O2O2 O2O2 HCO 3 - Cl - Na + H2OH2O CO 2 CO 2 + H 2 O ca H 2 CO 3 HCO 3 - H + K+K+ H2OH2O O2O2 } Hb } HHb HbO 2 CO 2 O2O2 Cl - CO 2

9 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 + + HCO 3 - -> H 2 CO 3 -> H CO 2. And the CO 2 in excess is released How is CO 2 expelled ?

10 A decrease in the strength of the carbaminic binds between Hb and CO 2 allows the release of CO 2 by 7-10% transferred in the form of carbo-hemoglobin Inside capillaries the effect leads to a higher intake of CO 2 in blood because O 2 is released from Hb Inside pulmonary alveoli the effect leads to a higher output of CO 2 from blood due to the fact that the Hb binds with O 2 How is CO 2 expelled ?

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12 The inclination of the solubility curve between 40 and 45 mmHg is 0,0045 (mL/mL)/mmHg Less than half of CO 2 released in lungs is due to the 5 mmHg excursion down the venous dissociation curve. The release of the remaining CO 2 occurs due to the downwards shift of the dissociation curve, meaning the Haldane effect occurring when the pO 2 changes from 40 mmHg (75% of O 2 saturation) to 100 mmHg (100% O 2 saturation)

13 The total quantity of CO2 in blood is proportional to its partial pressure

14 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

15 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

16 That’s why Abylcap was created for Lynda

17 Ossigenator CO2 O2

18 Characteristics The kit is made up of: 2 couples of Lines for extracorporeal circulation 2 heating Lines 1 Lilliput ECMO 2 Oxygenator Connectors

19 Main characteristics Lilliput ECMO2 Oxygenator Polymethylpentene membrane Membrane surface 0,67 m 2 Heater surface 0,02 m 2 Filling volume 90 ml Connections 1/4”- 5/16” Maximum flow 2300 ml/min 5 days duration ETO Sterilization

20 Non thrombogenic surfaces: PHISIO COATING COATINGCOATING

21 ECMOCPB Duration Characteristics of materials ECMO Vs CPB More than 21 daysMaximum 3,5 h

22 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 Polymethylpentene: the hollow fibres are protected by an external thin membrane. Gas transfer is obtained by diffusion. Plasma-tight membrane: POLYMETHYLPENTENE

23 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  m)  Suitable for long-lasting use

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25 Siggaard-Andersen

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27 1) resorption of HCO3- 2) regeneration of HCO3-.

28 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 CO 2 Removal

29 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: ECCO 2 R Ventilation, TPE Plasma exchange, CVVH, CVVHD, CVVHDF Acute Renal Failure and CPFA Sepsis.

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