CytoSorb in a case of pneumogenic septic shock and multiple organ failure

Dr. Markus Engel, Senior Consultant Medical ICU, Hospital Bogenhausen, Munich, Germany

Summary:

This case study reports on a 53-year-old male patient with sepsis and acute kidney failure who was admitted to the hospital from an external clinic via emergency helicopter transport.

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Case presentation

  • Before admission patient already experienced ten days of flu infection with cough and phlegm and also diarrhea and vomiting in the last three days and began to develop a pronounced exanthema
  • On admission on ICU the patient was in fulminant septic shock with need for high catecholamine doses and low oxygen saturation of 94% despite FiO2 of 1,0 and high airway pressures
  • Sonography revealed fluid-filled bowel loops reflecting paralytic ileus and enlarged kidneys on both sides indicative for acute renal failure
  • Extracorporeal lung replacement therapy was applied due to ventilation failure with global respiratory insufficiency and particular severe hypoxia
  • Due to 5-organ failure due to the massive inflammatory reaction and a sustained therapy-refractory septic shock state adjunctive treatment with CytoSorb was started

Treatment

  • Two CytoSorb treatment sessions over a total period of 48 hours
  • CytoSorb was used in conjunction with CRRT (multiFiltrate, Fresenius Medical Care) in CVVHD mode
  • Blood flow rate: 130 ml/min
  • Anticoagulation: citrate
  • Later on change to CVVHDF with heparin anticoagulation due to increasing liver failure
  • CytoSorb adsorber position: pre-hemofilter

Measurements

  • Demand for catecholamines
  • Lactate

Results

  • Hemodynamic stabilization of the patient with significantly decreased needs for catecholamines
  • Effective reduction of lactate levels during the CytoSorb sessions

Patient Follow-Up

  • In the further course diagnosis for toxic epidermolysis and suspected staphylococcal scaled skin syndrome
  • Another 20 days later second septic episode with repeated usage of CytoSorb again resulting in rapid improvement of the hemodynamic situation
  • After further stabilization surgical removal of necrotic tissue on extremities and upper limb with following local flap cosmetic surgery
  • Termination of renal replacement therapy
  • Finally, successful transfer of patient to a rehabilitation unit

Conclusions

  • Treatment with CytoSorb resulted in significant stabilization of hemodynamics with declining needs for catecholamines and an effective reduction of lactate levels
  • During the second septic episode again stabilization of the hemodynamic condition within a few hours during CytoSorb treatment