Victor Schwindenhammer1, Thibaut Girardot2,3, Kevin Chaulier4, Arnaud Grégoire1, Céline Monard1, Laetitia Huriaux1, Julien Illinger4, Véronique Leray1, Thomas Uberti1, Jullien Crozon-Clauzel1, Thomas Rimmelé1,5. 1. Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 2. Anaesthesia and Critical Care Medicine Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France, thibaut.girardot@chu-lyon.fr. 3. EA 7426 PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-bioMérieux-Hospices Civils de Lyon, Lyon, France, thibaut.girardot@chu-lyon.fr. 4. Intensive Care Unit, L'Hôpital Nord-Ouest, Villefranche-sur-Saône General Hospital, Gleizé, France. 5. EA 7426 PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-bioMérieux-Hospices Civils de Lyon, Lyon, France.
Abstract
BACKGROUND: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). SUMMARY: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74-87] SAPS II quartile and 70 vs. 98% for the [87-163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52-2.45] µg/kg/min; at 48 h it was 0.20 [0.09-1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.
BACKGROUND: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shockpatients requiring continuous renal replacement therapy (CRRT). SUMMARY: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74-87] SAPS II quartile and 70 vs. 98% for the [87-163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52-2.45] µg/kg/min; at 48 h it was 0.20 [0.09-1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.
Authors: Jan Bakker; Eduardo Kattan; Djillali Annane; Ricardo Castro; Maurizio Cecconi; Daniel De Backer; Arnaldo Dubin; Laura Evans; Michelle Ng Gong; Olfa Hamzaoui; Can Ince; Bruno Levy; Xavier Monnet; Gustavo A Ospina Tascón; Marlies Ostermann; Michael R Pinsky; James A Russell; Bernd Saugel; Thomas W L Scheeren; Jean-Louis Teboul; Antoine Vieillard Baron; Jean-Louis Vincent; Fernando G Zampieri; Glenn Hernandez Journal: Intensive Care Med Date: 2021-12-15 Impact factor: 17.440
Authors: Juan Carlos Ruiz-Rodríguez; Luis Chiscano-Camón; Adolf Ruiz-Sanmartin; Clara Palmada; Erika Paola Plata-Menchaca; Clara Franco-Jarava; Marcos Pérez-Carrasco; Manuel Hernández-González; Ricard Ferrer Journal: Front Med (Lausanne) Date: 2022-01-10