Effects of the timing and intensity of treatment on septic shock patients treated with CytoSorb^®: Clinical experience

Abstract

Introduction: A group of adult septic shock patients treated with hemoperfusion (HA) with the Cytosorb® associated with CVVHD were studied to determine (a) the effects of this technique on different clinical variables; and (b) the impact of the pre CytoSorb® interval and its intensity on the outcome. Methods: The catecholamine index (CI) and the pressure-catecholamine Index (PCAI) were used to assess the amount of catecholamine administered at baseline and during the procedure, respectively. The pre-treatment time was calculated since the onset of the septic-shock related hypotension and the initiation of the first session and the intensity was assessed considering either the total volume of blood processed and the duration of the HA. Results: Overall, 51 patients with septic shock (30 m, 21 f), age 68 years (IQR 59–76) were retrospectively enrolled in the study; 26 were discharged alive form the ICU (S) and 25 died in ICU (NS); in the S group either CI and PCAI decreased significantly but in NS the CI increased and the PCAI remained stable in NS. In S, the time elapsing from the onset of symptoms and the start of Cytosorb® was shorter than in NS; the duration of the treatment and the volume of blood processed were significantly higher in S than in NS. Conclusions: In this group of septic shock patients, the earlier initiation of Cytosorb®, its longer duration and the higher volume of blood processed were associated with a better survival.

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: An Indian perspective

“…The analysis showed that CytoSorb ® treatment was linked with improved survival rates in critically ill COVID-19 patients who received extracorporeal membrane oxygenation. Earlier changes might ensure an ongoing high removal capacity of the adsorber avoiding early saturation in situation with a high cytokine load for the device[ 22 ]. Therefore, a change of adsorber might be appropriate anytime between 6-24 h. It was discussed that it does not need to be changed earlier than 6 h as the device would work properly but a change should not occur later than 24 h to comply with the current IFU, also as no significant removal capacity beyond this point should be expected from the adsorber.…”

Impact of CytoSorb and CKRT on hemodynamics in pediatric patients with septic shock: the PedCyto study

“…As in studies evaluating CytoSorb use in the adult population, early initiation of treatment ( 13 , 37 ) and a large number of sessions ( 38 ) appeared to be the optimal setting for such therapy. In our cohort, therapy was initiated within 24 h from the onset of septic shock; this is not always feasible in randomized trials, as the need for written consent often delays the initiation of therapy beyond 48–72 h from the onset of shock.…”

Urgent Coronary Artery Bypass Grafting Complicated by Systemic Inflammatory Response from Fulminant Herpes Zoster Successfully Managed with Adjunct Extracorporeal Hemoadsorption: A Case Report

“…Removal of cytokines by hemoadsorption in patients with sepsis or systemic inflammatory response syndrome has recently gained increased interest in cardiac surgery [ 1 ]. However, patient selection and timing of application have become very important in this adjunctive therapeutic strategy [ 2 ]. In the current case, a severe systemic inflammatory response with significant clinical deterioration occurred directly after induction of anaesthesia triggering the decision to initiate intraoperative hemoadsorption once the patient was placed on CPB.…”

“…More evidence is needed to better define the value of hemoadsorption in cardiac surgery especially relating to appropriate patient selection and timing and dosing of application [ 2 , 5 ]. In 2016, Bernardi et al evaluated intraoperative hemoadsorption in elective CABG patients with no differences in regard to cytokine release [ 6 ].…”