“ADVOS” is an abbreviation for Advanced Organ Support.
“ADVOS multi” is the designation for the machine being used for organ support, whereby “multi” means that several organs (lung, liver, kidney) can be supported at the same time.
Of course, the device can be used for just the lungs and also for other individual organs.
“Scalable Support” means that, depending on the severity of the disease, for example one and the same machine can only support the lungs (CO2 removal). If over the course of the disease, increased organ support (e.g. kidney or liver) is needed then it can also be used to support these organs without the need for setting up the machine again or even changing the machine.
The most innovative aspect is the method by which the advantages of albumin dialysis (high detoxification performance) are combined with other advantages (low albumin consumption, high dialysate flow, low blood flow). In addition, the scalability, which is the possibility of supporting the lungs, the liver, the kidney and the acid-base balance with a single machine, is a novelty which so far is only possible with the ADVOS multi.
The method can be reimbursed for both kidney and liver dialysis. Reimbursement for CO2 removal is currently under review.
The cost of the treatment depends on several factors, such as whether the equipment is purchased, leased or provided by ADVITOS GmbH, either with or without a fixed consumption of consumables. For more details, please contact our sales representatives.
The cost of the equipment is dependent on several factors, such as whether the equipment is purchased, leased or provided by ADVITOS GmbH, either with or without a fixed agreed number of consumables. For more details, please contact our sales representatives.
The equipment can also be used in dialysis practices.
The machines are also loaned if a corresponding agreement is made with the hospital, the practice or the service provider. For more details, please contact us.
Since the company’s foundation in 2005, ADVITOS GmbH has devoted itself to developing effective multi-organ support. After numerous in-vitro, preclinical and clinical trials, the procedure was approved in Europe in 2011 and has met a strong positive response from clinical users.
The company is ISO 13485 & MDD 93/42 EEG Annex 11.3 certified and covers, as a comprehensive provider, complete development, as well as the production and qualification assurance for medical devices and the necessary treatment concentrates internally.
We gladly accept targeted applications for vacancies or initiative applications via our website.
The indications for ADVOS are listed in the following table.
The procedure is relatively contraindicated in children, pregnant women and nursing mothers, since there is no experience with these cases available so far. The procedure is contraindicated in patients with Creutzfeldt-Jakob infection due to the risk of cross-infection. In addition, the same contraindications apply as to common dialyzis.
ADVOS multi circuit is installed within the machine with two specially designed dialyzers.
The most innovative method is the method by which the advantages of albumin dialysis (high detoxification performance) are combined with other advantages (low albumin consumption, high dialysate flow, low blood flow). In addition, the scalability, which is the possibility of supporting the lungs, the liver, the kidneys and the acid-base balance with a single machine, a novelty which so far is only possible with ADVOS multi.
The procedure can be used as long as the treating physician considers it necessary, whereby the machine must be disinfected every 24h. Thus, with 2 machines an uninterrupted treatment is possible.
Treatment typically takes 8h or 24h, depending on the treatment goal. For example, a 24-hour, continuous treatment is useful for lung support; whereas, for liver or kidney dialysis, an 8-hour treatment can also be done. In general, the length of organ support depends on the attending physician. The method only requires disinfection of the machine every 24h. Thus, with 2 machines an uninterrupted treatment is possible.
Further options for organ support are in preparation, either in specially designed equipment or as a supplement within the ADVOS multi.
The number of treatments is dependent on the pathology. Typically patients are treated 5-10 times, but patients have already been treated up to 100 times.
Acidic and basic concentrates are used to reduce/elevante the pH in the two separate ADVOS regeneration circuits and to filter the toxins there.
Added acid and base are converted into water and saline in the ADVOS reservoir: HCl + NaOH => H2O + NaCl and finally disposed of via the filtrate of the cleaning circuit.
Added acid and bases are converted into water and saline in the ADVOS reservoir: HCl + NaOH => H2O + NaCl and finally disposed of in the filtrate of the cleaning circuit. The filtrate itself is disposed of using the container system into the hospital/practice waste disposal outlet via ADVOS multi’s liquid management system.
2 dialyzers are used in the purification circuit within the ADVOS multi-circuit (acid and base circulation), 2 additional dialyzers are used in blood circulation to ensure a high cleaning performance of the albumin dialysate.
For regulatory reasons, only ADVOS dialyzers can be used. If dialyzers not approved by ADVITOS GmbH are used, any liability and responsibility for any complications or side effects for the treated patient are the sole responsibility of the attending clinician.
ADVOS multi offers the following advantages over the competition:
Since the method is still very new, there are only a limited number of studies on animals and humans, which we would be pleased to send you. Further studies are underway or are being prepared, for example, our central patient register, in which almost every patient treated is compiled.
Previous studies have shown good treatment successes, especially in the early onset of treatment. For details, please subscribe to our Literature-Service or contact experienced users.
In contrast to all other combined dialysis equipment, ADVOS does not need a gas exchanger for CO2 removal, rather it uses a chemical process: physiologically in the body CO2 + H2O (carbon dioxide and water) is constantly in equilibrium with H+ + HCO3– (proton and bicarbonate), according to the so-called Henderson-Hasselbalch equation:
CO2 + H2O <-> H2CO3 <-> H+ + HCO3–
If on the right-hand side of the equation the proton (H+) and the bicarbonate (HCO3–) are removed, the body recreates the latter two from carbon dioxide (CO2) and water (H2O), thus reducing the CO2 on the left side of the equation.
If pH is increased in the ADVOS dialysate and the bicarbonate content is reduced at the same time, both protons (H+) and bicarbonate (HCO3–) move from the blood into the dialysate and the CO2 content in the blood is lowered.
The number of treatments is dependent on the pathology. Typically patients are treated 5-10 times, but patients have already been treated up to 100 times.
The method is particularly suitable for the following patients.
In the ADVOS multi circuit, the albumin dialysate is separated into 2 independent circuits and an acidic or basic concentrate is added. Increasing the pH in the acid circuit, positively charged substances (e.g. copper and CO2) are removed from the dialysate, while negatively charged substances (e.g. bilirubin and gall acids) are removed in the base cycle. Subsequently, the circuits merge and a reconstituted dialysate passe through the dialyzers.
All anticoagulants that are used for kidney dialysis can also be used in combination with ADVOS.
For the recommended dosage, please refer to our ADVOS Quick-Guide or use hospital standards. The operation of the ADVOS multi without any anticoagulation cannot be recommended.
The setup of the device takes approx. 30-45 minutes, depending on user experience.
We recommend a standard disinfection, which is always required after treatment. For patient changes, a subsequent Citrosterile disinfection is recommended.
In the container, both the dialysate and the filtrate are stored and thus a treatment independent of osmosis water access is possible.
The acannot be connected directly to the ring line, but the water supply system for the ADVOS multi containers can be directly connected to the ring line.
Of course the ADVOS multi can also be used for outpatient kidney dialysis.
The recommended anticoagulation method is citrate anticoagulation. It is recommended to use the regular laboratory chemical monitoring procedures and to pay particular attention to citrate accumulation in patients with liver failure. So far, there have been no reported problems with the ADVOS multi associated with citrate anticoagulation.
Citrate and calcium should be given according to the local clinical guidelines. You can find more information in the ADVOS Quick-Guide.
The ADVOS multi works with blood flow rates of up to max. 400 ml / min and dialysate flow rates of up to 60 L / h. The flow rates can be varied depending on the detoxification performance and indication.
Albumin (2 x 100 ml 20%) cannot be supplied by ADVITOS GmbH and must be ordered separately from the respective hospital pharmacy. Similarly, the substances used for anticoagulation (e.g. citrate, heparin) should be provided by the hospital.
No, the patient is not cooled, an integrated heating hose ensures a stable body temperature.
If the patient experiences heat loss, the blood is heated via a heating sheath on the tubing after the dialyzer.
No, an extra heating blanket is not required.
Yes, the ADVOS multi can be operated with citrate anticoagulation. In fact, citrate is the most commonly used method among users. It is recommended to use typical laboratory chemical control measures and to pay particular attention to citrate accumulation in patients with liver failure. So far, there have been no reported problems with the ADVOS multi associated with citrate anticoagulation.
Balancing is done by the integrated scales in the suspended container.
The ADVOS multi is currently used in intensive care units as well as in dialysis stations. On request, we will gladly provide you with corresponding reference addresses.
ADVOS treatment fluids differ from conventional dialysis fluids by the addition of albumin, which is significantly lower in comparison to competing systems. Bicarbonate can be added depending on the intended support target.
Treatment typically takes 8h or 24h, depending on the treatment goal. For example, a 24-hour, continuous treatment is useful for lung support; for liver or kidney dialysis, an 8-hour treatment can be sufficient. In general, the length of organ support depends on the decision of the attending physician. The method only requires disinfection of the machine every 24h. Thus, with 2 machines an uninterrupted treatment is possible.
New users are taken care of and trained by our experienced application specialists during initial on-site treatments. After that, we are available at any time via a 24/7 Hotline. 0800 43 72 92 74
Our 24/7 Hotline is at your disposal for any questions and any problems:
The method is currently used in several (university) clinics. Contact addresses are available on request.
The method can be reimbursed for both kidney and liver dialysis. Reimbursement for CO2 removal is under review. Details are available from our sales representatives.
The cost of the equipment depends on several factors, such as whether the equipment is purchased, leased or provided by ADVITOS GmbH, either with or without a fixed consumption agreed number of consumables. For more details, please contact us.
Please use our service hotline (0800 43 72 92 74) or contact us at:
ADVITOS GmbH
Agnes-Pockels-Bogen 1
80992 Munich
Germany
info@advitos.com
www.advitos.com
Phone: +49 89 411 18 42 00
Fax: +49 89 411 18 42 09