Series Sepsis

Hemoadsorption by CytoSorb in septic patients – a case series

Kogelmann K, Jarczak D, Scheller, M, Drüner M
Crit Care 2017; 21:74

Summary:

In this case series the authors evaluated the impact of CytoSorb, used as adjunctive...

Summary:

In this case series the authors evaluated the impact of CytoSorb, used as adjunctive therapy, on hemodynamics and clinically relevant outcome parameters in 26 critically ill patients with septic shock and need for renal replacement therapy. Treatment of these septic shock patients was associated with hemodynamic stabilization and a reduction in blood lactate levels. Actual mortality was lower than that predicted by the APACHE II score. This effect was more pronounced in patients where therapy was started within 24 hours after the diagnosis of sepsis. Medical patients seemed to benefit more than post surgical patients in terms of survival. Treatment with the CytoSorb was safe and well tolerated with no device related adverse events during or after the treatment sessions.

Case series of patients with severe sepsis and septic shock treated with a new extracorporeal sorbent

Laddomada T, Doronzio A, Balicco B
Critical Care 2016, 20(Suppl 2):P193

In this case series in 8 patientswith severe sepsis and septic shocktreated with CytoSorbthe authors...

In this case series in 8 patientswith severe sepsis and septic shocktreated with CytoSorbthe authors analyzedthe influence of CytoSorb on clinical outcomes such as mean arterial pressure (MAP), vasopressors need and inflammatory markers, like procalcitonin (PCT). There was an overall improvement of MAP with a rapid reduction in vasopressors dosages. Moreover, CytoSorb treatment in combination with CRRT was associated with a marked decrease of PCT levels and an improvement in renal function. In non-survivors, MAP was hard to stabilize and decreased and there was an aggravation in overall patients’ conditions. The authors conclude that a timely use of CytoSorb in combination with the standard therapy could have benefits in improving patients hemodynamic and helping a more rapid stabilization. However, more in vivo studies are needed to confirm these results.

Case study of 8 Patients with multiple organ failure treated additionally with Cytosorbentshaemadsorption as adjunctive therapy in septic shock and severe SIRS in cardiac failure

Kogelmann K, Drüner M, Jarczak D
Infection. 2015 Aug;43Suppl 1:1-73. Abstract No. 58

In this case series the authorsaimed to investigate the effectiveness of CytoSorb treatment in 8...

In this case series the authorsaimed to investigate the effectiveness of CytoSorb treatment in 8 patients with sepsis/SIRS and multiple organ failure. They found a pronounced decrease in catecholamine demand and distinct tendency in decrease of blood lactatelevelsduring the treatment period and within 72 h afterCytoSorbtherapy. However, no significant changes for SOFA-Scorenor SAPS II-Score were detected. Importantly, compared with overall survival of about 45 % in severesepsis including septic shock the authors could finda survival of 62.5 % in these patients. Treatment with CytoSorb was safe and without any noticed side effects.

Clinical experience of using a novel extracorporeal cytokine adsorption column for treatment of septic shock with multiorgan failure

Sathe P, Sakhavalkar P, Kumar S, Choudhary S
Critical Care 2015, 19(Suppl 1): P130

In this retrospective case series in 19 ICU patients treated with standard of care plus...

In this retrospective case series in 19 ICU patients treated with standard of care plus CytoSorbas adjuvant therapy the authors intended to analyze clinical safety, selection of a subgroup of patients where CytoSorb could be used, selection of timing for initiation, number of CytoSorb devices required per patient, and selective markers to identify its initiation. All of the patients had a high predicted mortality(APACHE II >17, SOFA >11). Four patients could be saved with use of CytoSorb therapy. Importantly, three of them were treatedearly (<24 hours of admission). APACHE scores decreased >5 points in five patients after single application of CytoSorb therapy. Of those patients who died, the majority (n = 11) could be given CytoSorb treatment only onceand seven were treated late (>24 hours).
The authors state that a better outcome could be expected if therapy was initiated earlier (<24 hours). However, future well-designed studies are needed to clarify the role of CytoSorb in patients with MOF/septic shock.

Early report: Theuse of Cytosorbhaemabsorption column as an adjunct in managing severe sepsis: initial experiences, review and recommendations

Morris C, Gray L, Giovannelli M
Journal of Intensive Care Society 2015; 16(3):257-64

In this article the authors describe the use of CytoSorbhemoadsorption device in 2 cases of...

In this article the authors describe the use of CytoSorbhemoadsorption device in 2 cases of patients with overwhelming sepsis following community acquired pneumonia. In addition, the authors consider the experience and hitherto evidence supporting the use of CytoSorb in clinical practice. They state that while Cytosorbhaemabsorption is mechanistically distinct from other extracorporeal therapies in sepsis and appears effective in reducing inflammatory cytokines during sepsis, much of the basic science and clinical benefits remain unclear. Suggestions for future research and how Cytosorbcould be incorporated into practice are provided.

Observations in early vs. late use of CytoSorb® haemadsorption therapy in critically ill patients

Kogelmann K, Druener M, Jarczak D
Critical Care 2016, 20(Suppl 2):P195

Aim of this case study conducted in 14 critically ill patients was to show the...

Aim of this case study conducted in 14 critically ill patients was to show the effectiveness of CytoSorb treatment used as adjunctive therapy. Increased survival occured if treatment with the hemadsorption filter was started early(<48 h after diagnosis of septic shock)and patients who had a greater delay in start of therapy (>48 h after diagnosis of septic shock)had poor outcome. Start of CytoSorb therapy in nonsurvivors was by far later than in survivors. After CytoSorb therapy a pronounced decrease of catecholamine demand (Norepinephrine μg/h vs. thereby achieved MAP) was observed with catecholamine demand decreasing 10-fold. Blood lactate level was divided into halves.These observations implicate that a preferably early start of therapy not later than 24 hours after diagnosis of septic shock / severe SIRS is crucial for survival.