Experience with hemoadsorption (CytoSorb ® ) in the management of septic shock patients.

Autor:	Mehta Y; Medanta The Medicity, Gurgaon 122001, Haryana, India. yatin.mehta@medanta.org., Mehta C; Medanta The Medicity, Gurgaon 122001, Haryana, India., Kumar A; Medanta The Medicity, Gurgaon 122001, Haryana, India., George JV; Medanta The Medicity, Gurgaon 122001, Haryana, India., Gupta A; Medanta The Medicity, Gurgaon 122001, Haryana, India., Nanda S; Medanta The Medicity, Gurgaon 122001, Haryana, India., Kochhar G; Medanta The Medicity, Gurgaon 122001, Haryana, India., Raizada A; Medanta The Medicity, Gurgaon 122001, Haryana, India.
Jazyk:	angličtina
Zdroj:	World journal of critical care medicine [World J Crit Care Med] 2020 Jan 31; Vol. 9 (1), pp. 1-12. Date of Electronic Publication: 2020 Jan 31 (Print Publication: 2020).
DOI:	10.5492/wjccm.v9.i1.1
Abstrakt:	Background: Cytokines and inflammatory mediators are the hallmarks of sepsis. Extracorporeal cytokine hemoadsorption devices are the newer clinical support system to overcome the cytokine storm during sepsis. Aim: To retrospectively evaluate the clinical outcomes of patients admitted in intensive care unit with septic shock with different etiologies. Methods: The laboratory parameters including biomarkers such as procalcitonin, serum lactate and C-reactive protein; and the hemodynamic parameters; mean arterial pressure, vasopressor doses, sepsis scores, cytokine levels and other vital parameters were evaluated. We evaluated these outcomes among survivors and non-survivors. Results: Of 100 patients evaluated, 40 patients survived. Post treatment, the vasopressors dosage remarkably decreased though it was not statistically different; 34.15% ( P = 0.0816) for epinephrine, 20.5 % for norepinephrine ( P = 0.3099) and 51% ( P = 0.0678) for vasopressin. In the survivor group, a remarkable reduction of biomarkers levels; procalcitonin (65%, P = 0.5859), C-reactive protein (27%, P = 0.659), serum lactate (27%, P = 0.0159) and bilirubin (43.11%; P = 0.0565) were observed from baseline after CytoSorb ® therapy. A significant reduction in inflammatory markers; interleukin 6 and interleukin 10; (87% and 92%, P < 0.0001) and in tumour necrosis factor (24%, P = 0.0003) was also seen. Overall, 28 (28%) patients who were given CytoSorb ® therapy less than 48 h after onset of septic shock survived and the maximum duration of stay for 70% of these patients in intensive care unit was less than 15 d. Conclusion: CytoSorb ® is a safe and well tolerated rescue therapy option in patients with septic shock. However, early (preferably within < 48 h after onset of septic shock) initiation could result in better clinical outcomes. Further randomized trials are needed to define the potential benefits of this new treatment modality. Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare. (©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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