Use of a novel hemoadsorption device for cytokine removal as adjuvant therapy in a patient with septic shock with multi-organ dysfunction: A case study
Reshma Basu, Sunjay Pathak, Jyoti Goyal, Rajeev Chaudhry, Rati B Goel, Anil Barwal, Reshma Basu, Sunjay Pathak, Jyoti Goyal, Rajeev Chaudhry, Rati B Goel, Anil Barwal
Abstract
CytoSorb(®) (CytoSorbents Corporation, USA) is a novel sorbent hemoadsorption device for cytokine removal. The aim of this study was to examine the clinical use of CytoSorb(®) in the management of patient with septic shock. We used this device as an adjuvant to stabilize a young patient with multi-organ failure and severe sepsis with septic shock. A 36-year-old female patient was hospitalized with the complaints of malaise, general body ache, and breathing difficulty and had a medical history of diabetes mellitus type II, hypertension, obstructive sleep apnea, hypothyroidism and morbid obesity. She was diagnosed to have septic shock with multi-organ dysfunction (MODS) and a low perfusion state. CytoSorb(®) hemoadsorption column was used as an attempt at blood purification. Acute physiology and chronic health evaluation score, MODS score, and sequential organ failure assessment score were measured before and after the device application. CytoSorb application as an adjuvant therapy could be considered in septic shock.
Keywords: CytoSorb; hemoadsorption; septic shock; systemic inflammatory response syndrome.
Conflict of interest statement
Conflict of Interest: None declared.
References
- Annane D, Aegerter P, Jars-Guincestre MC, Guidet B, CUB-Réa Network. Current epidemiology of septic shock: The CUB-Réa network. Am J Respir Crit Care Med. 2003;168:165–72.
- Taniguchi T, Hirai F, Takemoto Y, Tsuda K, Yamamoto K, Inaba H, et al. A novel adsorbent of circulating bacterial toxins and cytokines: The effect of direct hemoperfusion with CTR column for the treatment of experimental endotoxemia. Crit Care Med. 2006;34:800–6.
- Schädler D, Porzelius C, Jörres A, Marx G, Meier-Hellmann A, Putensen C, et al. A multicenter randomized controlled study of an extracorporeal cytokine hemoadsorption device in septic patients. Crit Care. 2013;17:62.
- Taniguchi T, Kurita A, Mukawa C, Yamamoto K, Inaba H. Dose-related effects of direct hemoperfusion using a cytokine adsorbent column for the treatment of experimental endotoxemia. Intensive Care Med. 2007;33:529–33.
- Peng ZY, Carter MJ, Kellum JA. Effects of hemoadsorption on cytokine removal and short-term survival in septic rats. Crit Care Med. 2008;36:1573–7.
- Honore PM, Jacobs R, Joannes-Boyau O, De Regt J, De Waele E, van Gorp V, et al. Newly designed CRRT membranes for sepsis and SIRS - A pragmatic approach for bedside intensivists summarizing the more recent advances: A systematic structured review. ASAIO J. 2013;59:99–106.
- Mitzner SR, Gloger M, Henschel J, Koball S. Improvement of hemodynamic and inflammatory parameters by combined hemoadsorption and hemodiafiltration in septic shock: A case report. Blood Purif. 2013;35:314–5.
- Kellum JA, Song M, Venkataraman R. Hemoadsorption removes tumor necrosis factor, interleukin-6, and interleukin-10, reduces nuclear factor-kappaB DNA binding, and improves short-term survival in lethal endotoxemia. Crit Care Med. 2004;32:801–5.
- Rimmelé T, Kaynar AM, McLaughlin JN, Bishop JV, Fedorchak MV, Chuasuwan A, et al. Leukocyte capture and modulation of cell-mediated immunity during human sepsis: An ex vivo study. Crit Care. 2013;17:R59.
- Kumagai T, Takeyama N, Yabuki T, Harada M, Miki Y, Kanou H, et al. Apheresis of activated leukocytes with an immobilized polymyxin B filter in patients with septic shock. Shock. 2010;34:461–6.
- Born F, Pichlmaier M, Peterss S, Khaladj N, Hagl C. Systemic inflammatory response syndrome in der herzchirurgie: Neue therapiemöglichkeiten durch den einsatz eines cytokin-adsorbers während. EKZ. 2014;23:41–6.
- Hetz H, Berger R, Recknagel P, Steltzer H. Septic shock secondary to ß-hemolytic streptococcus-induced necrotizing fasciitis treated with a novel cytokine adsorption therapy. Int J Artif Organs. 2014;37:422–6.
- Bracht H, Schneider EM, Weiss M, Hohmann H, Georgieff M, Barth E. Pattern of cytokine removal using an adsorption column CytoSorb during severe candida albicans induced septic shock. Infection. 2013;41:1–90.
Source: PubMed