Use of CytoSorb in the emergency department-high dependency unit: A case report and a mini review (original) (raw)
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Critical Care Research and Practice, 2021
The COVID-19 pandemic has led to the biggest global health crisis of our lifetime. There is accumulating evidence that a substantial number of critically ill COVID-19 patients exhibit a dysregulated host response manifesting as cytokine storm or cytokine release syndrome, which in turn contributes to the high observed rates of mortality. Just as in other hyperinflammatory conditions, extracorporeal cytokine removal may have potential beneficial effects in this subgroup of COVID-19 patients. The CytoSorb blood purification device is the most extensively investigated cytokine removal platform with considerable evidence suggesting that early intervention can provide rapid hemodynamic stabilization and improvement in vital organ functions. The purpose of this review is to provide an overview of the pathophysiological background of hyperinflammation in COVID-19 and to summarize the currently available evidence on the effects of hemoadsorption in these patients.
Trials, 2020
Objectives Approximately 8 - 10 % of COVID-19 patients present with a serious clinical course and need for hospitalization, 8% of hospitalized patients need ICU-treatment. Currently, no causal therapy is available and treatment is purely supportive. The main reason for death in critically ill patients is acute respiratory failure. However, in a number of patients a severe hyperinflammatory response with excessively elevated proinflammatory cytokines causes vasoplegic shock resistant to vasopressor therapy. A new polystyrene-based hemoadsorber (CytoSorb®, Cytosorbents Inc., New Jersey, USA) has been shown to adsorb effectively cytokines and other middle molecular weight toxins this way reducing their blood concentrations. This has been routinely used in clinical practice in the EU for other conditions where a cytokine storm occurs and an observational study has just been completed on COVID-19 patients. We hypothesized that the extracorporeal elimination of cytokines in critically ill...
2021
Introduction Sepsis and septic shock have mortality rates between 20% and 50%. In sepsis, the immune response becomes dysregulated, which leads to an imbalance between proinflammatory and anti-inflammatory mediators. When standard therapeutic measures fail to improve patients’ condition, additional therapeutic alternatives are applied to reduce morbidity and mortality. One of the most recent alternatives is extracorporeal cytokine adsorption with a device called CytoSorb. This study aims to compare the efficacy of standard medical therapy and continuous extracorporeal cytokine removal with CytoSorb therapy in patients with early refractory septic shock. Furthermore, we compare the dosing of CytoSorb adsorber device changed every 12 or 24 hours. Methods and analysis It is a prospective, randomised, controlled, open-label, international, multicentre, phase III study. Patients fulfilling the inclusion criteria will be randomly assigned to receive standard medical therapy (group A) or—i...
Dysregulated response of cytokines can result in hyper-inflammatory conditions called cytokine storm,commonly seen in sepsis and septic shock..The current study assessed hemoadsorption device-CytoSorb® for its efficiency as an adjuvant in treating patients suffering from septic shock. Total 8 patients enrolled were subjected to hemoadsorption therapy along with the standard treatment.The results of the study revealed significant improvement in clinical and haemodynamic parameters before and after initiation of CytoSorb® therapy. Out of 8 patients, 6 showed a positive outcome while 2 did not survive.The results of this study show that the use of hemoadsorption therapy can be considered in critically ill ICU patients as a safe and effective adjuvant therapy along with the standard treatment for a better outcome in patients.
Journal of Critical Care
Background: The aim of this proof of concept, prospective, randomized pilot trial was to investigate the effects of extracorporeal cytokine removal (CytoSorb®) applied as a standalone treatment in patients with septic shock. Methods: 20 patients with early (b24 h) onset of septic shock of medical origin, on mechanical ventilation, norepinephrineN10 μg/min, procalcitonin (PCT) N 3 ng/mL without the need for renal replacement therapy were randomized into CytoSorb (n = 10) and Control groups (n = 10). CytoSorb therapy lasted for 24 h. Clinical and laboratory data were recorded at baseline (T 0), T 12 , T 24 , and T 48 hours. Results: Overall SOFA scores did not differ between the groups. In the CytoSorb-group norepinephrine requirements and PCT concentration decreased significantly
The International Journal of Artificial Organs, 2019
Purpose: For the first time in Kazakhstan, we have used a combined extracorporeal support, by including the CytoSorb system in a continuous veno-venous hemofiltration system in an 8-month-old patient with a body weight of 5600 g. Results: The CytoSorb therapy session resulted in a reduction of inflammation markers IL-6, S100, procalcitonin, and C-reactive protein. Simultaneously, the level of transaminases, creatine kinase, and troponin were normalized, by the end of the session patient hemodynamics were stable and there was no need for vasopressors, acid–base balance was maintained, and the patient was weaned from mechanical ventilation to spontaneous breathing. Conclusion: Treatment using the CytoSorb device was safe and well-tolerated in a pediatric patient and has proven its practical value as an adjuvant therapy for sepsis in pediatric patient populations.
Can the Reduction of Cytokines Stop the Progression of Sepsis?
Cureus
In this study, we aimed to analyze the laboratory and clinical results of cytokine hemadsorption as an immunomodulation therapy in ICU patients diagnosed with sepsis or septic shock. Methods The levels of procalcitonin (PCT) and C-reactive protein (CRP), determined to be indicators of infection/sepsis, and the levels of interleukins (IL-6, IL-8, and IL-10) and tumor necrosis factor α (TNFα), deemed as indicators of the cytokine storm, were compared among 32 patients before and after the hemadsorption procedure. Results The hemadsorption significantly reduced the levels of IL-6, IL-8, IL-10, TNFα, PCT, CRP, Acute Physiology and Chronic Health Evaluation (APACHE) scores, mortality rate, and Sequential Organ Failure Assessment (SOFA) scores (p<0.05). APACHE scores and the mean predicted mortality rate (PMR) of the non-survivors measured before the procedure was significantly higher than those of survivors (p=0.002 for both). IL-10, APACHE scores, and the mortality rates determined before the hemadsorption procedure were deemed significant parameters to predict the mortality among all ICU patients (p<0.05). IL-10 levels ≤125.3 ng/L, APACHE score >30, and PMR >70.33 were significantly associated with the mortality rates of all patients, indicating that these three parameters determined before the hemadsorption may be good predictors of mortality among ICU patients with sepsis. Conclusion The progression of sepsis in ICU patients may be prevented with cytokine hemadsorption applied as an immunomodulator therapy.
Accepted for publication on September 14, 2007. SEPSIS: FROM BENCH TO BEDSIDE
2014
Sepsis is a syndrome related to severe infections. It is defined as the systemic host response to microorganisms in previously sterile tissues and is characterized by end-organ dysfunction away from the primary site of infection. The normal host response to infection is complex and aims to identify and control pathogen invasion, as well as to start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to both anti-inflammatory and proinflammatory responses. The chain of events that leads to sepsis is derived from the exacerbation of these mechanisms, promoting massive liberation of mediators and the progression of multiple organ dysfunction. Despite increasing knowledge about the pathophysiological pathways and processes involved in sepsis, morbidity and mortality remain unacceptably high. A large number of immunomodulatory agents have been studied in experimental and clinical settings in an attempt to find an efficacious anti-inflammatory ...
Issues in the adjunct therapy of severe sepsis
Journal of Antimicrobial Chemotherapy, 1996
Until recently the concept of immunomodulation in patients with severe sepsis (formerly called sepsis syndrome or septic shock) appeared very promising. Research has focused on the possible therapeutic potential of interfering with cytokine pathways, either by preventing the induction of cytokines, such as TNF-a, by neutralization of lipopolysaccharide (LPS), or through the use of agents that attenuate cytokine action. Nowadays research on protein or protein constructs with antibacterial activities such as bacterial/permeability increasing protein (BPI), platelet activating factor receptor antagonists, nitric oxide and cyclo-oxygenase inhibitors, are still being followed. In large clinical trials monoclonal antibodies against core glycolipid (E5, HAIA) were shown to be at best of only marginal benefit, and in some trials results were indecisive. Also, the results with IL-lra, although initially heralded with high expectation, were at the end disappointing and the trials discontinued. Two large trials with monoclonal antibodies against TNF showed some effect in subcategories of patients; a third trial is on its way. Other phase I, II studies include those of soluble TNF receptors and BPI. The area of immunomodulation has now become an area of more realism and the results of early trials has forced investigators to go back to the drawing board and to re-investigate the whole concept of immunotherapy and immunoprophylaxis.
Transfusion and Apheresis Science, 2020
There is still an evident need for useful biomarkers and effective therapeutic approaches regarding the challenging management of sepsis. The aim of the study is to evaluate the effect of each Cytosorb hemoadsorption therapy course on blood levels of inflammatory biomarkers of sepsis including endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein. Methods: There were a total of 178 samples belonging to 34 patients that were diagnosed with sepsis and undergone Cytosorb therapy during the study period. Patient demographics were recorded. Arterial blood samples were obtained both before and and after each Cytosorb course. Levels of copeptin, interleukin-6, procalcitonin, C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and creatinine were assessed both before and after each Cytosorb treatment. Results: Levels of endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein, and erythrocyte sedimentation rate were all significantly decreased after the Cytosorb course when compared with levels before therapy (p = 0.039, 0.001, 0.010, 0.001, 0.002 and 0.001, respectively). There was no significant difference between white blood cell count and creatinine levels before and after Cytosorb courses (p = 0.204 and 0.277). Conclusion: Cytosorb courses achieved significant decreases in endocan, copeptin, interleukin-6, procalcitonin and C-reactive protein levels. Decreasing plasma levels of inflammatory cytokines may help alleviate the cytokine storm and may have a role in improve outcomes. Further prospective randomized controlled studies with larger sample size are needed concerning the long-term effects of this decrease in cytokine levels on outcome and mortality.