Standard renal replacement therapy combined with hemoadsorption in the treatment of critically ill septic patients

Abstract

The aim of the study was to assess clinical and paraclinical effects of hemoadsorption on organ dysfunction, severity scores, and 28-day survival in septic patients. Fifty-five septic patients admitted to a general intensive care unit of a university hospital were included in the present study. Each patient underwent three consecutive 24-hour sessions of renal replacement therapy in combination with hemoadsorption. Clinical and paraclinical variables were measured after the treatment and severity scores were calculated. The use of hemoadsorption was associated with an increase in arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P = .02), urine output (P = .01), and Glasgow Coma Score (P = .03) and a decrease in white blood cell count (P = .03), C-reactive protein (P = .01), procalcitonin (P = .01) levels, and platelet count (P = .01). The use of hemoadsorption was associated with an improvement in neurological and renal functions and a decrease in inflammatory markers. Acute respiratory distress syndrome improved significantly based on relevant improvements in one-third of the patients.

The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

“…Out of the 163 clinical articles available in PubMed, 58 were identified that mentioned "catecholamines and/or vasopressors". In total, 25 papers were excluded; 12 because of non-comparability of the measurement scales [25][26][27][28][29][30][31][32][33][34][35][36]; 4 because the type and dose of vasopressors were not specified [37][38][39][40]; 1 that reported combined norepinephrine and epinephrine doses [41]; 1 that only reported on patients that had survived [42]; and 7 where there were no measurements pre-and post-adsorber use in the same patient [43][44][45][46][47][48][49]. The remaining 33 articles were summarized without considering different study designs or duration of treatment.…”

Adjuvant hemoadsorption therapy in patients with severe COVID-19 and related organ failure requiring CRRT or ECMO therapy: A case series

“…31–33 Despite precise mechanisms of action remaining speculative, a number of studies in various fields of use are in line with our findings concerning improvements in PaO 2 /FiO 2 ratio during the course of CytoSorb therapy. 22,24,34,35…”

Reduction of primary graft dysfunction using cytokine filtration following acute respiratory distress syndrome in lung transplantation

“…They have so far been employed in vivo during human orthotopic heart transplantation and in human kidney transplantation settings (25,26,52). In patients with severe sepsis and acute lung injury, the device was reported to have reduced the levels of IL-6, IL-8, IL-1β and TNF-α (28)(29)(30)(31)53). Based on the finding that the filtration is beneficial in ameliorating healthy lungs damaged by ischemia, it was then utilized in this study for its potential to rescue ARDS donor lungs for LTx (38,39).…”

“…Cytokine filtration has also been used to successfully treat sepsis and ALI by reducing the levels of cytokines such as IL-6, IL-1β and TNF-α in non-transplanted subjects. While cytokine filters are being studied in clinical trials for their therapeutics in patients with ARDS, they have not yet been explored in the context of rescuing donor lungs suffering from ARDS for later transplantation (27)(28)(29)(30)(31)(32). In general, there is a lack of options for treating ARDS lungs to render them suitable for transplantation but regenerating lungs with ARDS has particular clinical relevance in transplantation given the incidence of neurogenic pulmonary edema, a form of acute respiratory distress syndrome arising from compromise of the brainstem or hypothalamus (33).…”