Peter Pickkers1, Timon Vassiliou2, Valdis Liguts3, Federico Prato4, Pierre Tissieres5, Stephan Kloesel6, Franco Turani7, Dijana Popevski8, Marcus Broman9, Ciprian Mihai Gindac10, Faouzi Saliba11, Marco Tengattini4, Jacques Goldstein12, Kai Harenski13. 1. Department of Intensive Care Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands, peter.pickkers@radboudumc.nl. 2. Department of Anaesthesiology and Critical Care Medicine, Academic Medical Centre, Klinikum Darmstadt GmbH, Darmstadt, Germany. 3. Department of Acute Renal and Liver Replacement Therapy, Pauls Stradins Clinical University Hospital, Riga, Latvia. 4. Ospedale Degli Infermi, Intensive Care Unit, ASL Biella, Ponderano, Italy. 5. Hôpitaux Universitaires Paris-Sud, Pediatric Intensive Care, Le Kremlin-Bicêtre, France. 6. Department of Anesthesiology and Intensive Care, GPR Klinikum Ruesselsheim, Ruesselsheim, Germany. 7. Aurelia Hospital, Anaesthesia and Intensive Care, Rome, Italy. 8. Department of Anesthesia and Intensive Care, Zan Mitrev Clinic, Skopje, North Macedonia. 9. Perioperative and Intensive Care, Skåne University Hospital, Lund, Sweden. 10. Department of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu", Timisoara, Romania. 11. Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France. 12. Baxter World Trade SPRL, Acute Therapies Global, Braine-l'Alleud 1420, Belgium. 13. Baxter, Baxter Deutschland GmbH, Unterschleissheim, Germany.
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.
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 sepsispatients 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.