Methods for lipopolysaccharide (LPS) (endotoxin) reduction have been proposed as one way to improve the treatment of Gram-negative sepsis. Here we present a case with severe Gram-negative sepsis, treated with a novel device for LPS adsorption (Alteco LPS Adsorber, Alteco Medical AB, Lund, Sweden). After LPS adsorption, the level of LPS in the patient's bloodstream was almost eliminated: from 1.44 EU/ml before treatment to 0.03 EU/ml post treatment). The procalcitonin level and inflammatory cytokines were concurrently reduced. Also, an obvious improvement in the status of the patient's hemodynamics was seen. Forty-five days after treatment the patient is still alive. In conclusion, LPS adsorption may represent a significant improvement in the treatment of Gram-negative sepsis and further studies are planned.

Relevance. Acute respiratory infection COVID-19 caused by the SARS-CoV-2 (2019-nCov) coronavirus is severe and extremely severe in 15—20% of cases, which is accompanied by the need for respiratory support. Hyperbaric oxygenation is recognized as an effective therapy for replenishing any form of oxygen debt.Aim of study. To study the safety of HBO use in patients with COVID-19.Material and metods. We examined 32 patients with the diagnosis “Coronavirus infection caused by the virus SARS-CoV-2” (10 — moderately severe patients (CT 1–2), 22 — patients in serious condition (CT 3–4), who received course of hyperbaric oxygenation (HBO). The procedures were carried out in a Sechrist 2800 chamber (USA) at a mode of 1.4–1.6 AT for no more than 60 minutes. In total, the patients received 141 HBO sessions. Before and after each HBO session, the subjective indicators of the patient’s condition were assessed and the blood oxygen saturation was measured.Results. An algorithm for HBO course management was developed, which consists in using “soft” modes (up to 1.4 AT) during the first session, followed by pressure adjustment (not higher than 1.6 AT) during the course to achieve maximum therapeutic effect and comfort for the patient. Against the background of the HBO course, the patients showed an increase in blood oxygen saturation in patients in both surveyed groups, as well as positive dynamics in the form of a decrease in shortness of breath, an improvement in general well-being.Conclusion. The inclusion of daily sessions (at least 4) of hyperbaric oxygenation in “soft” modes (1.4–1.6 ATA) in the complex therapy for COVID-19 has shown its safety and preliminary positive effect on the subjective state of the examined patients and the dynamics of blood oxygen saturation.

PurposeTo describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS ) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (<2 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. ResultsThe cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs . 61.3%, p=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock .00]), late-onset hospital-acquired peritonitis ) and failed source control evidenced by persistent inflammation at Day 7 ). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality ). Conclusions 'Urgent' and successful source control were associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.

Background Vilobelimab, a complement 5a (C5a)-specific monoclonal antibody, reduced mortality in critically ill COVID-19 patients in a phase 3 multicentre, randomized, double-blind, placebo-controlled study. As part of the study, vilobelimab concentrations and C5a levels as well as antidrug antibodies (ADAs) to vilobelimab were analysed. Results From Oct 1, 2020 to Oct 4, 2021, 368 invasively mechanically ventilated COVID-19 patients were randomized: 177 patients were randomly assigned to receive vilobelimab while 191 patients received placebo. Pharmacokinetic sampling was only performed at sites in Western Europe. Blood samples for vilobelimab measurements were available for 93 of 177 (53%) patients in the vilobelimab group and 99 of 191 (52%) patients in the placebo group. On day 8, after three infusions, mean vilobelimab (trough) concentrations ranged from 21,799.3 to 302,972.1 ng/mL (geometric mean 137,881.3 ng/mL). Blood samples for C5a measurements were available for 94 of 177 (53%) patients in the vilobelimab group and 99 of 191 (52%) patients in the placebo group. At screening, C5a levels were highly elevated and comparable between groups. In the vilobelimab group, median C5a levels were 118.3 ng/mL [IQR 71.2–168.2 ng/mL] and in the placebo group, median C5a levels were 104.6 ng/mL [IQR 77.5–156.6 ng/mL]. By day 8, median C5a levels were reduced by 87% in the vilobelimab group (median 14.5 ng/mL [IQR 9.5–21.0 ng/mL], p < 0.001) versus an 11% increase in the placebo group (median 119.2 ng/mL [IQR 85.9–152.1 ng/mL]). Beyond day 8, though plasma sampling was sparse, C5a levels did not reach screening levels in the vilobelimab group while C5a levels remained elevated in the placebo group. Treatment-emergent ADAs were observed in one patient in the vilobelimab group at hospital discharge on day 40 and in one patient in the placebo group at hospital discharge on day 25. Conclusions This analysis shows that vilobelimab efficiently inhibits C5a in critically ill COVID-19 patients. There was no evidence of immunogenicity associated with vilobelimab treatment. Trialregistration ClinicalTrials.gov, NCT04333420. Registered 3 April 2020, https://clinicaltrials.gov/ct2/show/NCT04333420

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