The Supporting Role of Combined and Sequential Extracorporeal Blood Purification Therapies in COVID-19 Patients in Intensive Care Unit

Nalesso, Federico; Stefanelli, Federica L.; Vico, Valentina Di; Cattarin, Leda; Cirella, Irene; Scaparrotta, Giuseppe; Garzotto, Francesco; Calò, Lorenzo A.

doi:10.3390/biomedicines10082017

Cited by 3 publications

(7 citation statements)

References 69 publications

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“…Toxic digestive enzymes released into the systemic circulation by the diseased pancreas are responsible for renal damage. The autolysis releases active enzymes, such as amylases, esterases, and nucleases, and inactive proenzymes, such as proteinase, peptidases and phospholipase A. Phospholipase A, which is activated by trypsin, releases highly toxic lysolecithin from lecithin, which can damage the organs in particular the kidneys leading to AKI [29].…”

Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

“…A ratio of > 5 in patients with high triglyceride concentrations is four times higher than in those with normal triglycerides [49]. Acute pancreatitis is one of the most severe complications of severe hypertriglyceridemia [29]. The primary goal in these patients is a rapid lowering of the excessively elevated triglycerides, activated enzymes, released cytokines and other inflammatory substances.…”

Section: Nephrogenic Systemic Fibrosis (Nsf)mentioning

confidence: 99%

“…The autolysis of the pancreatitis releases active enzymes such as lipase, amylase, esterase, and nuclease, as well as inactive-pro-enzymes such as proteinase, peptidase, phospholipase A, trypsin, and others [29]. Phospholipase A, which is activated by trypsin, releases highly toxic lysolecithin from lecithin.…”

Section: Hyperlipidemic Pancreatitismentioning

confidence: 99%

“…Oxygen radicals such as oxy-reductase, which is toxic for tissue, also play an important role in the pathogenesis. Acute pancreatitis can be connected to AKI [29].…”

Section: Hyperlipidemic Pancreatitismentioning

confidence: 99%

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Therapeutic Apheresis and Human Monoclonal Antibodies in Non-Immunologic Diseases. TA, HMA in non-immunologic diseases

2023

JCEI

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Non-immunologic diseases such as nephrological, blood diseases, dyslipoproteinemia, cancer, infections, intoxications etc. have often a severe course or a bad prognosis. Since more than 45 years, therapeutic apheresis has led in combination with other therapies to a steady increase in survival rates. Therapeutic apheresis is indicated in the most of the non-immunologic diseases, and in all antibody-mediated diseases. Since the introduction of hollow fiber membranes, a complete separation of the corpuscular components, pathologic substances, antibodies, toxins etc. is reached. The mortality rate of severe non-immunologic diseases is reduced by therapeutic apheresis. Other new therapies are various human monoclonal antibodies alone or in combination with therapeutic apheresis. The pathological aspects, the first-line and second-lines therapies for non-immunologic such as nephrological, neurological, gastroenterological, hematological diseases, and others are shown. The guidelines of the Apheresis Applications Committee of the American Society for Apheresis are cited. Therapeutic apheresis and/or human monoclonal antibodies have shown to effectively cure severe diseases without immunologic origin.

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Section: Acute Kidney Injury (Aki)mentioning

confidence: 99%

Section: Nephrogenic Systemic Fibrosis (Nsf)mentioning

confidence: 99%

Section: Hyperlipidemic Pancreatitismentioning

confidence: 99%

“…Oxygen radicals such as oxy-reductase, which is toxic for tissue, also play an important role in the pathogenesis. Acute pancreatitis can be connected to AKI [29].…”

Section: Hyperlipidemic Pancreatitismentioning

confidence: 99%

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Therapeutic Apheresis and Human Monoclonal Antibodies in Non-Immunologic Diseases. TA, HMA in non-immunologic diseases

2023

JCEI

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“…Ronco et al ( 5 ) and others ( 6 ) have recently proposed an intriguing therapeutic strategy of sequential extracorporeal therapies in the treatment of sepsis. This would aim at targeting the variety of physiologic steps that occur during the disease process.…”

mentioning

confidence: 99%

Sequential Extracorporeal Therapy of Pathogen Removal Followed by Cell-Directed Extracorporeal Therapy in Streptococcal Toxic Shock Syndrome Refractory to Venoarterial Extracorporeal Membrane Oxygenation: A Case Report

Amerson,

Hoffman,

Abouzahr

et al. 2024

Critical Care Explorations

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BACKGROUND: Streptococcal toxic shock syndrome (STSS) is a fulminant complication of predominantly invasive group A streptococcal infections. STSS is often characterized by influenza-like symptoms, including fever, chills, and myalgia that can quickly progress to sepsis with hypotension, tachycardia, tachypnea, and multiple organ failure (kidney, liver, lung, or blood). Mortality can exceed 50% depending on the severity of symptoms. CASE SUMMARY: Here, we describe a novel, multi-extracorporeal intervention strategy in a case of severe septic shock secondary to STSS. A 28-year-old woman 5 days after cesarean section developed STSS with respiratory distress, hypotension, and multiple organ failure. Despite conventional therapy with intubation, antibiotics, vasopressors, and fluid resuscitation, her condition worsened. She was placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with subsequent initiation of pathogen hemoperfusion using the Seraph 100 blood filter, followed by immunomodulation with the selective cytopheretic device (SCD). No device-related adverse events were observed. The patient’s condition gradually stabilized with discontinuation of vasopressors after 4 days, ECMO decannulation after 6 days, evidence of renal recovery after 7 days, and extubation from mechanical ventilation after 14 days. She was transferred to conventional hemodialysis after 13 days and discontinued all kidney replacement therapy 11 days later. CONCLUSIONS: This is the first reported use of VA-ECMO, Seraph 100 hemoperfusion, and cell-directed immunomodulation with SCD. This multimodal approach to extracorporeal support represents a promising therapeutic strategy for the most refractory critical care cases. Further studies are needed to assess the safety and efficacy of this sequential approach.

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Efficacy of additional hemoperfusion in hospitalized patients with severe to critical COVID-19 disease

Chiewroongroj,

Ratanarat,

Naorungroj

et al. 2024

Sci Rep

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The evidence supporting additional hemoperfusion (HP) with cytokine adsorbents for improving clinical outcomes in severe to critical coronavirus disease 2019 (COVID-19) patients remains limited. We compared severe to critical COVID-19 patients who received additional HP with a cytokine adsorbent to matched cases receiving standard medical treatment (SMT). The primary outcome was hospital mortality. In our study, we matched 45 patients who received additional HP 1:1 with the SMT group based on key clinical parameters. The hospital mortality rates did not differ between the groups (33% vs 38%, p = 0.83). The HP group had a significantly shorter ICU stay (22 vs 32 days; p = 0.017) and reduced mechanical ventilation duration (15 vs 35 days; p < 0.001). Additionally, the incidence of pulmonary complications (20% vs 42%; p = 0.04), sepsis (38% vs 64%; p = 0.02), and disseminated intravascular coagulopathy (DIC) (13% vs 33%; p = 0.046) were significantly lower in the HP group. In conclusion, among severe to critical COVID-19 patients, additional HP with a cytokine adsorbent did not improve hospital mortality. However, it reduced ICU length of stay, mechanical ventilator days, and incidences of lung complications, sepsis, and DIC. Trial registration : TCTR20231002006. Registered 02 October 2023 (retrospectively registered).

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The Supporting Role of Combined and Sequential Extracorporeal Blood Purification Therapies in COVID-19 Patients in Intensive Care Unit

Cited by 3 publications

References 69 publications

Therapeutic Apheresis and Human Monoclonal Antibodies in Non-Immunologic Diseases. TA, HMA in non-immunologic diseases

Therapeutic Apheresis and Human Monoclonal Antibodies in Non-Immunologic Diseases. TA, HMA in non-immunologic diseases

Sequential Extracorporeal Therapy of Pathogen Removal Followed by Cell-Directed Extracorporeal Therapy in Streptococcal Toxic Shock Syndrome Refractory to Venoarterial Extracorporeal Membrane Oxygenation: A Case Report

Efficacy of additional hemoperfusion in hospitalized patients with severe to critical COVID-19 disease

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