CytoSorb in a case of postoperative sepsis in a patient with necrotizing pancreatitis

Lutz Badura, Hospital Eilenburg

Summary:

This case study reports on a 65-year-old female patient with underlying cholelithiasis undergoing a surgical procedure for severe necrotizing pancreatitis

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Case presentation

  • Postoperatively progressing demand for catecholamines, and signs for multiple organ failure (lung, circulatory, kidney, gut)
  • Sharp increase of PCT and CRP

Treatment

  • Three consecutive CytoSorb treatment sessions of 23 hours each over a total period of 72 hours, separated from one another by a pause interval of 1 hours
  • Cytosorb was used in conjunction with CRRT (machine Baxter BM11a/BM14) run in CVVHF mode
  • Blood flow rate: 120 ml/min
  • Anticoagulation: citrate
  • CytoSorb adsorber position: pre-hemofilter

Measurements

  • IL-6, PCT, CRP
  • Demand for catecholamines
  • Renal function

Results

  • Treatment resulted a stabilization of the hemodynamic condition with decreased need for catecholamines
  • Declining plasma levels of markers of infection and inflammation
  • Marked improvement of renal function with beginning diuresis already during the treatment

Patient Follow-Up

  • Despite regular lavage in the following days and an initial control of the systemic, inflammatory situation the patient suffered a relapse with multiple organ failure in the further course and died

Conclusions

  • In this patient, treatment with CytoSorb resulted in a significant stabilization of hemodynamics with declining needs for catecholamines and improving organ functions especially of the kidney
  • Handling of the absorber was easy and intuitive