Burkhard Hinz1, Oliver Jauch1, Toralf Noky1, Sigrun Friesecke2, Peter Abel2, Rolf Kaiser3. 1. Department of Anesthesiology and Intensive Care Medicine, KMG Clinic Güstrow, Güstrow - Germany. 2. Department of Internal Medicine and Intensive Care Medicine, University Medicine Greifswald, Greifswald - Germany. 3. Department of Internal Medicine and Intensive Care Medicine, KMG Clinic Güstrow, Güstrow - Germany.
Abstract
INTRODUCTION: Hemoadsorption using CytoSorb has gained attention as a potential immunotherapy to control systemic inflammation and sepsis. We report on a patient with septic shock, successfully treated with CytoSorb therapy. METHODS: A 72-year-old male with periodically recurring infectious episodes was admitted with the suspicion of urosepsis. In the following hours his hemodynamic situation deteriorated markedly, exhibiting respiratory-metabolic acidosis, elevated inflammatory marker plasma levels, a severely disturbed coagulation, increased retention parameters, liver dysfunction, and confirmation of bacteria and leucocytes in urine. After admission to the ICU in a state of septic shock the patient received renal support with additional hemoadsorption using CytoSorb. Three CytoSorb sessions were run during the following days. RESULTS: The first and consecutive second session resulted in a reduction of procalcitonin, C-reactive protein and bilirubin and a markedly reduced need for vasopressors while hemodynamics improved significantly (i.e., cardiac index, extravascular lung water). Due to a recurring inflammatory "second hit" episode, another session with CytoSorb was run, resulting in a marked decrease in leukocytosis and liver (dys)function parameters. CONCLUSIONS: The rapid hemodynamic stabilization with reduction of vasopressor needs within hours and reduction of the capillary leakage as well as a quick reduction in infection markers were the main conclusions drawn from the use of CytoSorb in this patient. Additionally, treatment appeared to be safe and was well tolerated. Despite the promising results of CytoSorb application in this patient, further studies are necessary to elucidate to what extent these favorable consequences are attributable to the adsorber itself.
INTRODUCTION: Hemoadsorption using CytoSorb has gained attention as a potential immunotherapy to control systemic inflammation and sepsis. We report on a patient with septic shock, successfully treated with CytoSorb therapy. METHODS: A 72-year-old male with periodically recurring infectious episodes was admitted with the suspicion of urosepsis. In the following hours his hemodynamic situation deteriorated markedly, exhibiting respiratory-metabolic acidosis, elevated inflammatory marker plasma levels, a severely disturbed coagulation, increased retention parameters, liver dysfunction, and confirmation of bacteria and leucocytes in urine. After admission to the ICU in a state of septic shock the patient received renal support with additional hemoadsorption using CytoSorb. Three CytoSorb sessions were run during the following days. RESULTS: The first and consecutive second session resulted in a reduction of procalcitonin, C-reactive protein and bilirubin and a markedly reduced need for vasopressors while hemodynamics improved significantly (i.e., cardiac index, extravascular lung water). Due to a recurring inflammatory "second hit" episode, another session with CytoSorb was run, resulting in a marked decrease in leukocytosis and liver (dys)function parameters. CONCLUSIONS: The rapid hemodynamic stabilization with reduction of vasopressor needs within hours and reduction of the capillary leakage as well as a quick reduction in infection markers were the main conclusions drawn from the use of CytoSorb in this patient. Additionally, treatment appeared to be safe and was well tolerated. Despite the promising results of CytoSorb application in this patient, further studies are necessary to elucidate to what extent these favorable consequences are attributable to the adsorber itself.
Authors: Maryann C Gruda; Karl-Gustav Ruggeberg; Pamela O'Sullivan; Tamaz Guliashvili; Andrew R Scheirer; Thomas D Golobish; Vincent J Capponi; Phillip P Chan Journal: PLoS One Date: 2018-01-25 Impact factor: 3.240