CytoSorb in a case of severe burn injury (60% BSA) and sepsis

Prof. Dr. med. Peter Mailänder & Dr. med. Eirini Liodaki
Plastic Surgery Unit, UKSH Campus Lübeck, Germany

Summary:

This case study reports on a 51-year-old patient who was admitted to hospital with severe burn injury (60% BSA) and inhalation trauma due to an explosion accident.

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Case presentation

  • Instantaneous initial treatment with bath therapy, tracheotomy and escharotomy on both legs due to circular burns grade 3
  • From day two acute kidney failure with indication for dialysis
  • In the further course daily routine dressing changes, in total seven operations with debridement and split skin grafts
  • 27 days after admission development of severe sepsis
  • Proven microbial species: Enterococcus faecium, Escherichia coli, Staphylococcus epidermidis, Aspergillus fumigatus (tracheal secretion negative)
  • Antibiotic therapy with meronem, voriconazol, linezolid
  • High demand for catecholamines (noradrenaline 3.6mg/h, vasopressin 2.4IE/h, dobutamine 45mg/h)
  • Mechanical ventilation: high peak inspiratory pressures, high FiO2
  • Severely impaired renal function with increased retention parameters and anuria
  • Massive myoglobinemia (15696 µg/l) and significantly elevated inflammatory parameters (CRP 275 mg/l, PCT 28.75 µg/l, WBC 15500/µl)
  • Due to the progressive need for catecholamine and massive myoglobinemia a CytoSorb adsorber was added into the CRRT circuit

Treatment

  • Three CytoSorb treatment sessions for three days with treatment time of 24 hours each
  • CytoSorb was used in conjunction with CRRT (Prismaflex, Gambro) in CVVHD mode
  • Blood flow rate: 200 ml/min
  • Anticoagulation: heparin
  • CytoSorb adsorber position: post-hemofilter

Measurements

  • Demand for catecholamines
  • Renal function (creatinine, urea, excretion)
  • Myoglobin
  • Inflammatory parameters (CRP, PCT, WBC)

Results

  • Hemodynamic stabilization of the patient with significantly decreased needs for catecholamines (noradrenaline 0.6mg/h, dobutamine 5mg/h )
  • Significantly declining renal retention parameters and reduction of inflammatory parameters (CRP 237 mg/l, PCT 10.78 µg/l, WBC 9.900/µl)
  • Reduction of myoglobin plasma levels to 7944 µg/l during the three CytoSorb sessions

Patient Follow-Up

  • In the further course continuation of intensive care treatment
  • Termination of renal replacement therapy after 70 treatment days (43 days after initial CytoSorb treatment)
  • Patient stable, free of mechanical ventilation and capable for rehab
  • Finally, successful transfer of patient to a rehabilitation unit

Conclusions

  • Treatment with CytoSorb resulted in significant stabilization of hemodynamics with declining needs for catecholamines as well as control of the septic episode and myoglobinemia
  • CytoSorb was safe and easy to apply