Experience with hemoadsorption (CytoSorb?) in the management of septic shock patients

• 作者: Aditi Gupta Arun Raizada Ashish Kumar Chitra Mehta Gourav Kochhar Joby Varghese George Saurabh Nanda Yatin Mehta
• 来源期刊: 世界重症医学杂志
• 学科: 医学
• 关键词: Hemoadsorption SEPSIS CYTOKINES CLINICAL conditions INFLAMMATION and EXTRACORPOREAL
• 年，卷（期）: 2020,（1）
• 页码范围: 1-12
• 页数: 12页
• 分类号: R73

摘要

BACKGROUND Cytokines and inflammatory mediators are the hallmarks of sepsis.Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis.AIM To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies.METHODS The laboratory parameters including biomarkers such as procalcitonin,serum lactate and C-reactive protein;and the hemodynamic parameters;mean arterial pressure,vasopressor doses,sepsis scores,cytokine levels and other vital parameters were evaluated.We evaluated these outcomes among survivors and non-survivors.RESULTS Of 100 patients evaluated,40 patients survived.Post treatment,the vasopressors dosage remarkably decreased though it was not statistically different;34.15%(P=0.0816)for epinephrine,20.5%for norepinephrine(P=0.3099)and 51%(P=0.0678)for vasopressin.In the survivor group,a remarkable reduction of biomarkers levels;procalcitonin(65%,P=0.5859),C-reactive protein(27%,P=0.659),serum lactate(27%,P=0.0159)and bilirubin(43.11%;P=0.0565)were observed from baseline after CytoSorb^? therapy.A significant reduction in inflammatory markers;interleukin 6 and interleukin 10;(87%and 92%,P<0.0001)and in tumour necrosis factor(24%,P=0.0003)was also seen.Overall,28(28%)patients who were given CytoSorb^? therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70%of these patients in intensive care unit was less than 15 d.CONCLUSION CytoSorb^? is a safe and well tolerated rescue therapy option in patients with septic shock.However,early(preferably within<48 h after onset of septic shock)initiation could result in better clinical outcomes.Further randomized trials are needed to define the potential benefits of this new treatment modality.