Download Minimally invasive extracorporeal CO2 removal

Method
500
400
300
200
Oxygen
100
20
40
60
80
Considering a metabolic production of CO2
at rest up to 250 mL/min, an effective removal should approach this value to control the
breathing workload and to avoid respiratory
acidosis in patients with hypercapnic respiratory failure. Alongside traditional techniques
100
pO2, pCO2 (mmHg)
of respiratory assistance, a device that performs an extracorporeal CO2 removal facilitates and extends their
current applications [11].
CO2
Due to the transport properties of blood, an
extracorporeal CO2 removal treatment can also
be efficiently performed using blood flows
lower then 500 mL/min, well below
the cardiac output.
Pulmonary
elimination
In addition, an appropriate instrument and the low blood flow allow
the profitable adoption of a single,
small, veno-venous vascular access.
Extracorporeal
removal
CO2
Minimally invasive extracorporeal CO2 removal system using continuous hemoperfusion.
Technical characteristics
Treatment mode
Hemoperfusion
Blood flow
100-450 mL/min
Membrane type
Phosphorylcholine-coated polymethylpentene
Membrane surface
1.8 m2
Priming volume
220 mL
Sterilization
Ethylene oxyde
Single circuit lasting
5 days
Rinsing and priming
2L saline heparinized by 10000 UI
Vascular access
13-14 Fr double lumen central venous catheter
Codes
Description
Validity
PLFLOW
ESTORFLOW® CO2 removal blood pump
PLMETER
ProLUNG Meter® integrated module for continuous monitoring
of removed CO2 and medical gas management
PLLUNG5MD
ProLUNG PLUS MD kit for extracorporeal CO2 removal
3 years
CATFX1320
“High Flow” double lumen catheter (optional)
5 years
References
CO2
Peripheral
methabolic
intake
1. The acute respiratory distress syndrome network.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute
respiratory distress syndrome. N Eng J Med 2000; 342 (18): 103-1308.
2. Hager DN, Krishnan JA, Hayden DL et al.Tidal Volume Reduction in Patients with Acute Lung Injury When Plateau Pressures Are Not High. Am J Respir Crit Care
Med 2005; 172: 1241-1245.
3. Determann RM, Royakkers A, Wolthuis EK et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without
acute lung injury: a preventive randomized controlled trial. Crit Care 2010; 14: R1-R14.
4. Confalonieri M, Garuti G, Cattaruzza MS et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J 2005; 25: 348-355.
5. Conti G, Antonelli M, Navalesi P et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of
medical treatment in the ward: a randomized trial. Int Care Med 2002; 28(12): 1701-7.
6. Prekker ME, Nath DS,Walker AR.Validation of the proposed International Society for Heart and Lung Transplantation grading system for primary graft dysfunction
after lung transplantation. J Heart Lung Transplant 2006; 25(4): 371-8.
7. Brian JE. Carbon Dioxide and the Cerebral Circulation. Anesthesiology 1998; 88(5): 1365-86.
8. Kolobov T, Gattinoni L, Tomlinson TA et al. Control of breathing using an extracorporeal membrane lung. Anesthesiology 1977; 46: 138-141.
9. Baumann MH, Sahn SA. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest 1990; 97: 721-8.
10.Schinco MA, Formosa VA, Santora TA.Ventilatory management of a bronchopleural fistula following thoracic surgery. Respir Care 1998; 43: 1064-9.
11.Gattinoni L, Carlesso E, Langer T. Towards ultraprotective mechanical ventilation. Curr Opin Anaesthesiol 2012; 25(2): 141-7.
ESTOR S.P.A.
Via Newton, 12 - 20016 Pero (MI) ITALY
Tel. +39 (0) 23394161 - Fax +39 (0) 233912069
[email protected] • www.estor.it
60517000 03/2014 REV. 0
Gas concentration (mL/L)
Blood tranports carbon dioxyde as dissolved, bound to hemoglobin and mainly under bicarbonate form.
This triple mode allows to transport a huge amount of carbon dioxyde per unit of blood volume. As
a consequence, a significant reduction of total
blood CO2 content could be obtained by treat600
ing little amounts of blood per unit of time
Carbon dioxyde
when an effective device is used.
550
Minimally invasive
extracorporeal CO2
removal system
Indications
The ProLung® System
Carbon dioxide is continuously produced by cell respiration. The lungs are the organs responsible to its
elimination. In cases of defect in alveolar ventilation, an acute accumulation of carbon dioxide (hypercapnia)
and a subsequent significant decrease in pH (respiratory acidosis) could occur. The control of hypercapnia
and respiratory acidosis allows to limit their effects on the central nervous and cardiovascular systems,
as well as metabolic disorders. An adequate correction of hypercapnia and respiratory acidosis induced in
various pathological conditions could be obtained by conventional techniques. However, in some cases, the
conventional approach is no longer sufficient:
“Exhacerbated COPD”
Air flow
VCO2 [ml/min]
“Primary graft
dysfunction”
In the postoperative period of
lung transplantation, in patients
who develop primary graft dysfunction [6], associated with severe hypercapnia, extracorporeal
CO2 removal allows to limit high
pressure and volume of ventilation, otherwise harmful to the
transplanted organ.
CO2
“Traumatic brain
injury”
In patients with head injury and
respiratory failure, extracorporeal CO2 removal helps to control intracranial pressure [7],
added to the limitation of pressures and volumes of ventilation
and the potential damage induced by mechanical ventilation
on the lung.
MEDICAL AIR + CO2
BLOOD
RETURN
ProLung
In patients with ALI/ARDS and severe hypercapnia, refractory to a
protective mechanical ventilation
[1,2], the extracorporeal CO2 removal allows to limit pressure and
volume of ventilation, otherwise
necessary to control respiratory
acidosis, but harmful to the lung
(barotrauma and volutrauma) [3].
In presence of tissue lesions of
respiratory system (bronchopleural fistula, rupture of the trachea or diaphragmatic injury), the
adoption of minimum volumes and
reduced ventilation pressures accelerates healing. Extracorporeal
CO2 removal facilitates the adoption of minimally invasive ventilatory strategies [8-10], useful for
these pathological conditions.
MEDICAL AIR
BLOOD
UPTAKE
HEPARIN
140
140
120
120
100
Removed CO2
100
60
40
4
20
2
[[mL/min]
mL/min]
0
0
5
10
15
20
25
30
Time (hours)
35
40
45
50
Air temperature
p
37
[[°C]
°C ]
TTreatment
re
eatment d
data
ata
SSetpoint:
etpoint: 37
The ProLung® circuit adopts
the simple veno-venous hemoperfusion mode to remove
CO2 within the filter. The extracorporeal support of a single circuit can last up to 5 days.
The ProLung® filter made
by high performance Phosphorylcholine-coated polymethylpentene, ensures CO2
removal higher than 100 mL/
min, in best usage conditions.
MEDICAL AIR
MEDICAL AIR + CO2
The Estorflow® hemoperfusion module adopts the volumetric control of blood flow, allowing flows of up to 450 mL/min.The pump characteristics ensure a flow rate almost constant
to varying inflow and outflow blood pressures of the circuit.This optimizes blood flow also
using minimally invasive catheters.
PRESSURE
“Tissue lesions”
[[L/min]
L/min]
80
• Autonomously manage medical air supplied to the
ProLung® filter, by means of a feedback communica tion with the Estorflow® hemoperfusion module
• Measure CO2 removed by the filter
• Plot and store CO2 removal data and patients characteristics
During an exacerbation of the
disease, in patients with respiratory acidosis refractory to NIV
support [5], the extracorporeal
removal of CO2 allows to extend
the application of NIV support,
avoiding intubation and related
infectious complications and hospital stay [5].
“ALI / ARDS”
8
The ProLung-Meter is the gas control unit of the
ProLung® system, designed to:
®
Volumetric
pumps
Centrifugal
pumps
FLOW RATE
The Estorflow® module communicates realtime the treatment status to the gas control unit
ProLung-Meter®, in order to ensure high standards
of safety in the control of gas exchange.