Adsorption capabilities of various extracorporeal devices for blood purification in increasing concentration of lipopolysaccharide. (In vitro benchmark experiment on fetal bovine serum)

Бабаев, М А; Dymova, O.V.; Matveeva, N.A.; Eremenko, A.A.

doi:10.17116/anaesthesiology202105140

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…In an in vitro study by Malard et al comparing the ability to adsorb inflammatory mediators, PMX-HP showed a significantly higher endotoxin clearance rate than AN69-oXiris in the first 30 min ( 14 ). In another in vitro study, AN69-oXiris cleared endotoxin at a rate of 10% after 4 h, whereas PMX-HP still had a clearance rate of 70% after 4 h ( 15 ). The device adsorption capacity, which refers to the amount of endotoxin a device can eliminate from whole blood, is 64 μg for PMX-HP compared to 1–8 μg for AN69-oXiris ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, few studies have compared the clinical efficacy of different hemoperfusion modalities. Thus, no standardized indication for different modalities of hemoperfusion treatment ( 3 , 14 , 15 ). Herein, we compared the clinical effectiveness of AN69-oXiris and PMX-HP in patients who underwent emergent surgery due to abdominal septic shock.…”

Section: Introductionmentioning

confidence: 99%

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The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

Kim,

Chung,

Lee

et al. 2024

Front. Med.

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PurposeIn septic shock patients, pathogens and excessive endotoxins continuously overstimulate the host’s immune system with a cytokine storm that can lead to multi-organ failure and even mortality. Various types of extracorporeal blood purification treatments have recently been introduced to remove excessive endotoxins and cytokines. Herein, we compared the clinical efficacy of two blood purification methods, PMX-HP and AN69-oXiris, and discussed their detailed indications according to disease severity.Materials and methodsFrom December 2016 to April 2023, patients who underwent emergent surgery due to septic shock secondary to peritonitis and subsequently received blood purification treatment with AN69-oXiris or PMX-HP were enrolled. Propensity score (PS)-matching was conducted to adjust for baseline characteristics between the two groups, and the changes in clinical parameters and outcomes were compared. Clinical outcomes were assessed in subgroups of patients who underwent PMX-HP treatment divided according to SOFA scores into low (0–7), intermediate (8–13), and high (> 13) disease severity groups.ResultsForty patients received blood purification therapy with either PMX-HP or AN69-oXiris during the study period. After 1:2 PS matching, six patients in the AN69-oXiris group and 12 patients in the PMX-HP group were finally analyzed. Vasoactive-inotropic scores (VISs) decreased in both groups after 48 h of treatment compared to the baseline values, but the change in VISs was more pronounced in the PMX-HP group {−57.6 [interquartile range (IQR) = −166.4 – (−10)] vs. -22.9 [IQR = −64–0], respectively, p = 0.041}. Decreases in cardiovascular SOFA scores were significantly pronounced in the PMX-HP group [−1.5 (IQR = −4 – 0) vs. 0 (IQR = −1 – 1), respectively, p = 0.035]. The 7-day mortality rate was significantly lower than the predicted mortality rate in a subgroup analysis of patients treated with PMX-HP in both the low disease severity group and the intermediate disease severity group.ConclusionPMX-HP and AN69-oXiris could be therapeutic options for refractory septic shock patients with intra-abdominal origins, especially after the surgical elimination of the infectious sources. A tailored modality choice that takes into account patient characteristics, such as disease severity and cost burden, could optimize the efficacy of this strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

Kim,

Chung,

Lee

et al. 2024

Front. Med.

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Dynamics of endotoxin activity and cytokine concentration in patients with septic shock and acute kidney injury undergoing various methods of extracorporeal detoxification

Kim¹,

Проценко²,

Magomedov³

et al. 2022

Anaes. i reanim.

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Septic shock in obstetrics: the role of efferent techniques for endotoxin removal in Gram-negative sepsis

Bayalieva,

Davydova

2024

Akušerstvo, ginekologiâ i reprodukciâ

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Aim: to assess the sorption capacity of various devices for endotoxin removal modelled in in vitro patient with septic shock experiment.Materials and Methods. Endotoxin adsorption was evaluated in vitro by using circulating endotoxin solution in bovine serum in a closed circuit. The following columns were chosen for the experiment: Toraymyxin PMX-20R (РМХ), Alteco® LPS Adsorber, Efferon LPS, Toray Filtryzer BK-2.1U. Lipopolysaccharide (LPS) doses corresponding to severity of the septic process were sequentially added to a column pre-washed with physiological solution. The first LPS dose of 12.5 μg was added to a flask containing 1500 ml (1.5 L) of fetal bovine serum, a second LPS dose of 37.5 μg was added to the serum samples collected before the onset of experiment, as well as 30, 60, 120 (before the second dose), 120 (after the second dose), 150 and 240 minutes after the start of circulation. LPS measurement was carried out by mixing the prepared serum sample with LAL reagent at 1:1 ratio in a measuring tube.Results. All columns can reduce endotoxin levels below the 12.5 μg and even 50 μg levels, although none of devices were able to reduce the LPS level from “supercritical” 50 μg to “critical” 12.5 μg. However, at the same time, the capacity of the Toraymyxin PMX-20R column turned out to be 5–13 times greater than that of other products. This result suggests that while removing endotoxin under similar conditions, the Toraymyx in PMX-20R column will have a much higher reserve of sorption capacity and, therefore, greater opportunities for lowering a risk of septic shock progression.Conclusion. The work we presented provides insights into whether sorption capacity of the presented cartridges is sufficient to remove endotoxin at initial (12.5 μg) load that corresponds to the onset of systemic inflammatory response syndrome in a typical patient. Additionally, it elucidates to what extent a cartridge can reduce the endotoxin load in severe septic shock with a total LPS load of up to 50 μg.

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Adsorption capabilities of various extracorporeal devices for blood purification in increasing concentration of lipopolysaccharide. (In vitro benchmark experiment on fetal bovine serum)

Cited by 4 publications

References 22 publications

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP

Dynamics of endotoxin activity and cytokine concentration in patients with septic shock and acute kidney injury undergoing various methods of extracorporeal detoxification

Septic shock in obstetrics: the role of efferent techniques for endotoxin removal in Gram-negative sepsis

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