Bellco srl Lynda CRRT machine CVVH PEX

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Bellco srlLynda CRRT machineCVVH PEX
CPFA Presentation
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Versatile for the physician, functional for the
nurse, effective for the patient. A simple answer
to complex questions from the Abyle line
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(No Transcript)
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Therapeutic versatility

• Wide range of options

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

• Wide range of options
• Continual monitoring of hematocrit and oxygen
  saturation
• 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 and gives
it a clinical meaning
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Therapeutic versatility

• Wide range of options
• Continual monitoring of hematocrit and
  oxygen saturation

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

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Therapeutic versatility

• Wide range of options
• Continual monitoring of hematocrit and oxygen
  saturation

• Program the infusion system in pre-dilution,
  post-dilution, or pre-post dilution
  simultaneously
• Filtration fraction control (ff).

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Therapeutic versatility

• Wide range of options
• Continual monitoring of hematocrit and oxygen
  saturation

• Program the infusion system in pre-dilution,
  post-dilution, or pre-post dilution
  simultaneously
• Filtration fraction control (ff).
• 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

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Functionality

•  Automatic priming in all treatment methods.

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Functionality

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

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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.

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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
  between two scales, saving
  time and reducing
  the possibility of error

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Effectiveness

• 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.
  

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Effectiveness

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

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SCUF(SLOW CONTINUOUS ULTRAFILTRATION)
Uf
EMOFILTRO
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CVVH, IHF-HVHF(CONTINUOUS VENO-VENOUS
HEMOFILTRATION, INTERMITTENT HEMO FILTRATION
HIGH VOLUME HEMOFILTRATION, SINGLE NEEDLE
HEMOFILTRATION)
Post diluizione (20100)
Uf
EMOFILTRO
Infusione o anticoagulante
Pre diluizione (080)
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SN HF(SINGLE NEEDLE HEMOFILTRATION)
Uf
EMOFILTRO
Infusione o anticoagulante
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PEX (PLASMA EXCHANGE)
Liquido di sostituzione
Post diluizione
Plasma
PLASMAFILTRO
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CPFA
anticoagulante
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Effectiveness

• Disposable Plug Play
• CPFA a targeted response to sepsis

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What is Sepsis ?ACCP/SCCM Consensus Definitions

• 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

• 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

Bone RC et al. Chest. 19921011644-55.
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Therapeutic Strategies
Systemic inflammatory response
Multi-organ dysfunction
Infection
Endothelial Dysfunction
Cell activation
Eliminate infection antibiotics
Reduce systemic reaction Steroids Insulin
(glucose control) Xigris
Support organs Ventilation CRRT
IV fluids Vasopressors
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Coupled Plasma Filtration Adsorption
Plasma
UF out
reinfusion in
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Therapeutic goal
Separate and retain toxins from a complex
mixture
Time 0
later
toxins
Physiologicalgood molecules
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Ideal therapy for sepsis
Plasma
bad molecules
good molecules
Dialysate out
Dialysate in
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What can the CPFA resin adsorb?

• Macrophage inflammatory protein-a (MIP-a)
• Macrophage inflammatory protein-b (MIP-b)
• Tumor necrosis factor-aTNF-a
• Monocyte chemotactic protein (MCP-1)
• RANTES
• Epithelial neutrophil activating peptide 78
  (ENA-78)
• Angiogenin

• Interleukin 1b
• Interleukin 5
• Interleukin 6
• Interleukin 7
• Interleukin 8
• Interleukin 10(?)
• Interleukin 12p70
• Interleukin 16
• Interleukin 18

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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.
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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