25/2016
CytoSorb in septic shock and multi organ failure after burn injury

Dr. Markus Engel Senior Consultant Medical ICU, Hospital Bogenhausen

Summary:

This case study reports on a 27-year-old patient who was admitted to emergency department in status post burn injury (25% TBSA)

 

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Case presentation

  • Burn injury of face, arms, hands and lower legs on both sides after flash fire during work as craftsman. Primary care by emergency physician on site including intubation and analgosedation and subsequent transport to hospital by helicopter
  • On admission intubated and ventilated and with stable circulation requiring low dose catecholamine administration. Primary wound care and vacuseal dressing of both hands
  • On day 3 uneventful extubation with stable pulmonary and circulatory functions not requiring catecholamine administration
  • Here after debridement and closure of arm and leg wounds with Suprathel
  • In the following, however worsening of the cardiopulmonary and renal functions and after the pressure supported NIV approach had failed the indication for intubation was given. In the course of that further deterioration of circulatory instability requiring high dose administration of norepinephrine. Decreasing diuresis despite high doses of furosemide.
  • Chest x-ray diagnosis showed progressive pulmonary alterations in terms of ARDS. Echocardiography showed only low grade reduced left ventricular function and no real cardiac dysfunction.
  • Due to multiple organ failure because of the massive inflammatory reaction as well as the persisting high doses of catecholamines needed (norepinephrine up to 5mg/h) treatment with CytoSorb was started after renal failure had also required CRRT.

Treatment

  • One CytoSorb treatment sessions for a total period of 24 hours
  • CytoSorb was used in conjunction with CRRT (multiFiltrate, Fresenius Medical Care) in CVVHD mode
  • Anticoagulation: citrate
  • CytoSorb adsorber position: pre-hemofilter

Measurements

  • Demand for catecholamines
  • Lactate
  • IL – 6 levels

Results

  • Quick hemodynamic stabilization of the patient with significantly decreased needs for catecholamines initially and complete tapering of catecholamines after 48 hrs.
  • Effective reduction of lactate and IL-6 levels during the CytoSorb sessions

Patient Follow-Up

  • Proof of 3MRGN Pseudomonas as well as diagnosis of HIT
  • In the further course end of CRRT and extubation of (tracheotomized) patient
  • Finally discharge with stable overall situation and plain wound conditions

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Conclusions

  • Treatment with CytoSorb resulted in a significant and quick stabilization of hemodynamics as well as an effective reduction of lactate and IL-6 plasma levels
  • Treatment was easy to apply and safe