3 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
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 tissuesARDS (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 BrainHow is CO2 distributed?HeartCO2 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 waterKidney
6 } Tissues Plasma Red blood cell Capillary wall CO2 O2 Hb 3-5% 85-90% HCO3-Cl-Na+H2OCO2 + H2O ca H2CO3HCO3- H+K+}HbHHbHbO2Caboemoglobina3-5%85-90%7-10%Cl-
7 How does CO2 move “through” the red blood cells?Spreading from the tissues into the red blood cells, the CO2 catalyzes the hydration reaction through carbonic anhydrase: CO2 + H20 -> H2CO3Then 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-)
8 } Capillary wall CO2 O2 Hb Lung Plasma Red Blood Cell HCO3-Cl-Na+H2OCO2 + H2O ca H2CO3HCO3- H+K+}HbHHbHbO2CaboemoglobinaLungPlasmaRed Blood Cell
9 How is CO2 expelled ?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
10 How is CO2 expelled ?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-hemoglobinInside capillaries the effect leads to a higher intake of CO2 in blood because O2 is released from HbInside pulmonary alveoli the effect leads to a higher output of CO2 from blood due to the fact that the Hb binds with O2
12 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)
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
21 Characteristics of materials ECMO Vs CPBECMOCPBDurationCharacteristics of materialsMore than 21 daysMaximum 3,5 h
22 Plasma-tight membrane: POLYMETHYLPENTENE Fibres in Polypropylene: gas comes into contact with blood through microporous fibres. The gas transfer is obtained through direct contact.Polypropylene “standard“ membraneFibres in Polymethylpentene: the hollow fibres are protected by an external thin membrane. Gas transfer is obtained by diffusion.Polymethylpentene “plasma-tight“ membrane
23 Plasma-tight membrane: POLYMETHYLPENTENE OUTER SURFACEPolymethylpentene “plasma-tight“ fibreMain 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 usePolypropylene “standard“ fibre
27 1) resorption of HCO3-2) regeneration of HCO3-.
28 APPLICATION IN INTENSIVE CARE Lynda is the first example of multidisciplinary approachCPFA Treatment for patients with severe sepsis, septic shock or MOFIntermittent Treatments for Renal FailureContinuous Treatments for Renal FailureTherapeutic Plasma Exchange TreatmentsTreatments for CO2 Removal
29 Thanks to Lynda, Bellco can propose to the I.C. Units a CONCLUSIONSThanks 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.