Alteco endotoxin hemoadsorption in Gram-negative septic shock patients

Shum, HP; Chan, KL; Wu, Yan

doi:10.1186/cc12006

Cited by 2 publications

(6 citation statements)

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“…Table 1), and the mean age was 59 years. Twenty-one studies started treatment within 24 h of sepsis diagnosis [9, 19, 36, 37, 41, 44-46, 48-53, 56, 58, 60, 62, 65, 68, 69]. In the other studies, treatment was initiated up to 6 days from diagnosis of sepsis.…”

Section: Resultsmentioning

confidence: 99%

“…Duration of treatment varied from 1 to 96 h spread over 1–7 days. Fourteen studies used CVVH [19, 37, 47, 50, 51, 53, 56, 57, 60, 63, 66-69], 17 used endotoxin adsorption [7, 9, 34, 38, 42-46, 48, 52, 55, 58, 59, 64, 65, 70], 3 used nonspecific adsorption [39, 40, 68], 2 used cytokine removal [54, 62], 2 used CPFA [41, 61], 2 used combined CVVH and adsorption [49, 68], and 1 used plasma exchange [36].…”

Section: Resultsmentioning

confidence: 99%

“…Clinical trials evaluating CVVH as an adjunct therapy in sepsis have used exchange rates between 1 L/h [53] and 120 mL/kg/h [51]. Of the 17 studies using endotoxin adsorption devices, including 15 used polymyxin B (PMXB) hemoperfusion (Toray Industries, Japan, and Spectral Medical Inc., Canada) [7, 9, 34, 38, 42-46, 48, 55, 59, 64, 65, 70], 1 used the Fresenius Matisse EN 500 iHSA endotoxin adsorber (Fresenius SE & Co., Bad Homburg, Germany), and 1 an Alteco® absorber (Alteco Medical AB, Lund, Sweden) [52, 58]. Two studies used the CytoSorb (CytoSorbents Corporation, Monmouth Junction, NJ, USA) [54, 62] cytokine removal device, and 3 used nonspecific absorbers: 2 the HA330 (Lizhu Industries, Shanghai, China) [39, 40] and 1 the Adsorba® 300 (Baxter, Deerfield, IL, USA) [68].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported the change in vasopressor requirement within 24 h [61,65], 2 studies reported at 48 h [19,62], 1 study between ICU admission and day 4 [52], and the others reported the change between ICU admission and day 3. Compared to standard care, the use of endo Change in SOFA score was reported in 3 studies using CVVH [56,66,69], 4 studies using endotoxin removal devices [34,48,52,58], 2 using nonspecific adsorption [39,40], and 1 study using CytoSorb [62]. The reported change in SOFA score was between days 3 and 14 from admission.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis

et al. 2020

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Objective: The objective of this study was to conduct a meta-analysis and trial sequential analysis (TSA) of published randomized controlled trials (RCTs) to determine whether mortality benefit exists for extracorporeal blood purification techniques in sepsis. Data Sources: A systematic search on MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for RCTs was performed. Study Selection: RCTs investigating the effect of extracorporeal blood purification device use on mortality among critically ill septic patients were selected. Data Extraction: Mortality was assessed using Mantel-Haenszel models, and I2 was used for heterogeneity. Data are presented as odds ratios (OR); 95% confidence intervals (CIs); p values; I2. Using the control event mortality proportion, we performed a TSA and calculated the required information size using an anticipated intervention effect of a 14% relative reduction in mortality. Data Synthesis: Thirty-nine RCTs were identified, with 2,729 patients. Fourteen studies used hemofiltration (n = 789), 17 used endotoxin adsorption devices (n = 1,363), 3 used nonspecific adsorption (n = 110), 2 were cytokine removal devices (n = 117), 2 used coupled plasma filtration adsorption (CPFA) (n = 207), 2 combined hemofiltration and perfusion (n = 40), and 1 used plasma exchange (n = 106). On conventional meta-analysis, hemofiltration (OR 0.56 [0.40–0.79]; p < 0.001; I2 = 0%), endotoxin removal devices (OR 0.40 [0.23–0.67], p < 0.001; I2 = 71%), and nonspecific adsorption devices (OR 0.32 [0.13–0.82]; p = 0.02; I2 = 23%) were associated with mortality benefit, but not cytokine removal (OR 0.99 [0.07–13.42], p = 0.99; I2 = 64%), CPFA (OR 0.50 [0.10–2.47]; p = 0.40; I2 = 64%), or combined hemofiltration and adsorption (OR 0.71 [0.13–3.79]; p = 0.69; I2 = 0%). TSA however revealed that based on the number of existing patients recruited for RCTs, neither hemofiltration (TSA-adjusted CI 0.29–1.10), endotoxin removal devices (CI 0.05–3.40), nor nonspecific adsorption devices (CI 0.01–14.31) were associated with mortality benefit. Conclusion: There are inadequate data at present to conclude that the use of extracorporeal blood purification techniques in sepsis is beneficial. Further adequately powered RCTs are required to confirm any potential mortality benefit, which may be most evident in patients at greatest risk of death.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

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Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis

et al. 2020

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“…With the increasing incidence of nosocomial infections, multidrug resistant organisms, inappropriate use of antibiotics and with only a limited availability of newer drugs, we need to focus on other innovative therapies such as discussed in the current article by Shum et al . [ 1 ] on extracorporeal removal of endotoxins.…”

mentioning

confidence: 99%

Endotoxin hemadsorption in septic shock

Sunavala

Mascarenhas

2014

Indian Journal of Critical Care Medicine

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Alteco endotoxin hemoadsorption in Gram-negative septic shock patients

Cited by 2 publications

References 1 publication

Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis

Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis

Endotoxin hemadsorption in septic shock

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