Sepsis Management with a Blood Purification Membrane: European Experience

Abstract

Background: Septic shock is a leading cause of acute kidney injury (AKI). Endotoxins and cytokine levels are associated with the occurrence and severity of AKI, and different blood purification devices are available to remove them from circulation. One such device, oXiris, is a hollow-fibre purification filter that clears both endotoxins and cytokines. Due to limited evidence, clinical use of this device is not currently advocated in guidelines. However, clinics do regularly use this device, and there is a critical need for guidance on the application of it in sepsis with and without AKI. Method: A modified Delphi-based method was used to collate ­European experts’ views on the indication(s), initiation and discontinuation criteria and success measures for oXiris. Results: A panel of 14 participants was selected based on known clinical expertise in the areas of critical care and sepsis management, as well as their experience of using the oXiris blood purification device. The participants used different criteria to initiate treatment with oXiris in sepsis patients with and without AKI. Septic shock with AKI was the priority patient population, with oXiris used to rapidly improve haemodynamic parameters. Achieving haemodynamic stability within 72 h was a key factor for determining treatment success. Conclusion: In the absence of established guidelines, users of hollow-fibre purification devices such as oXiris may benefit from standardised approaches to selecting patients and initiating and terminating treatment, as well as measuring success. Further evidence in the form of randomised clinical trials is urgently required.

Role of Hemoperfusion With CytoSorb Associated With Continuous Kidney Replacement Therapy on Renal Outcome in Critically III Children With Septic Shock

“…Some important aspects need to be elucidated with further studies, primarily the best timing to start with this type of adjunctive therapy and the potential removal of antibiotics or other useful drugs with the two devices. As it has been debated for CKRT about right time and the potential role of CKRT without AKI as a preemptive strategy to protect renal function and gain hemodynamic stability, the same concept should be applied for hemoperfusion with CytoSorb as it has emerged that removal of inflammatory mediators from the bloodstream is thought to possibly improve clinical outcomes ( 29 ). We would also underline the synergistic action between hemoperfusion and CKRT: this latter is very helpful correcting fluid overload, electrolytic and acid-base imbalance, which is why we always combine these two techniques and the extremely high surface membrane of cartridge used for the hemoperfusion, to implement the adsorptive action of medium size molecules with a huge removal from the bloodstream and the tissue ( 30 , 31 ).…”

Alprostadil attenuates LPS-induced cardiomyocyte injury by inhibiting the Wnt5a/JNK/NF-κB pathway

“…Sepsis is a systemic inflammatory response syndrome (SIRS) usually caused by endotoxin [30]. Myocardial injury, known as septic cardiomyopathy (SC), is one of the most serious complications of sepsis.…”

Continuous venovenous hemodiafiltration using cytokine-adsorbing hemofilters as adjuvant therapy for anaerobic descending necrotizing mediastinitis: a case report

“…Our patient likely benefited from the early use of CVVHDF-CAH (oXiris®) set at a high filtration rate to achieve adequate removal of harmful proinflammatory mediators [19,[41][42][43]. Also, the use of intermittent extracorporeal blood hyperoxygenation [44] promotes peripheral tissue vascularization [45,46].…”