scholarly journals What Have We Learned about the Use of Cytosorb Adsorption Columns?

2019 ◽  
Vol 48 (3) ◽  
pp. 196-202 ◽  
Author(s):  
Ghada Ankawi ◽  
Yun Xie ◽  
Bo Yang ◽  
Yuanyuan Xie ◽  
Pan Xie ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Treatment Strategies ◽  
High Volume ◽  
Blood Purification ◽  
Quality Level ◽  
Level Of Evidence ◽  
Extracorporeal Blood Purification ◽  
Plasma Filtration ◽  
High Volume Hemofiltration ◽  
Novel Applications

Extracorporeal blood purification techniques have emerged and evolved in the recent years as a potential therapy for the purpose of immunomodulation in acute conditions like sepsis. Understanding the extent of immune system dysregulation involved in the pathophysiology of these conditions, resulted in the development of such treatment strategies aiming at restoring a balanced inflammatory response. Beyond conventional continuous renal replacement therapy, high volume hemofiltration, high cut-off membranes, adsorption alone and coupled plasma filtration adsorption are well-described techniques in the literature. The evidence to support their routine use, however, is conflicting and insufficient at this stage. Despite the low-quality level of evidence in favor of utilizing these techniques, studies to further explore their effectiveness, safety, and potential novel applications, continue to evolve. Our review aims at focusing on adsorption therapy, particularly using the adsorption columns Cystosorb.

Extracorporeal Blood Treatment (EBT) Methods in SIRS/Sepsis

2005 ◽  
Vol 28 (5) ◽  
pp. 450-458 ◽  
Author(s):  
R. Bellomo ◽  
P. Honoré ◽  
J. Matson ◽  
C. Ronco ◽  
J. Winchester
Keyword(s):  
High Volume ◽  
Future Research ◽  
Technical Management ◽  
Extracorporeal Blood ◽  
Future Research Agenda ◽  
Extracorporeal Blood Purification ◽  
Consensus Statements ◽  
Plasma Filtration ◽  
High Volume Hemofiltration ◽  
Refractory Septic Shock

Background Extracorporeal blood purification treatment (EBT) methods have been used in the treatment of experimental and human SIRS/Sepsis in a variety of settings and with variable reports of efficacy and safety. Their role in the management of SIRS/Sepsis remains controversial. Objectives To develop consensus statements regarding important aspects of research, practice and technical management concerning EBT. Methods Systematic review of published study. Evidence-based grading of information available. Consensus development regarding fundamental questions about EBT. Results Consensus was achieved on all questions posed during the conference. It was agreed that there is currently a clear biological rational for EBT in SIRS and Sepsis. It was agreed that conventional CVVH has sufficiently been shown not to be effective in SIRS/Sepsis in the absence of concomitant ARF and that other therapies such as plasmapheresis or high-volume hemofiltration or coupled plasma filtration adsorption appear more promising and should be tested in multicentre randomized controlled trials. Patients with ARF and SIRS/Sepsis should be treated differently from those with ARF alone even though current practice in this field is not well known. Patients with refractory septic shock should be considered for EBT. Appropriate end points for clinical trials can be defined and chosen according to the goals of the trial. Different technologies exist for EBT and better understanding of the merits and safety of each is needed as well as better standardization of methodology and dose. Conclusions Broad consensus can be achieved on several aspects of EBT and can be used to inform clinical practice and to help guide the establishment of a future research agenda.

Plasma Filtration Adsorption Dialysis (PFAD): A New Technology for Blood Purification

2005 ◽  
Vol 28 (7) ◽  
pp. 731-738 ◽  
Author(s):  
F. Nalesso
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Severe Sepsis ◽  
Inflammatory Mediators ◽  
High Volume ◽  
Blood Purification ◽  
Plasma Filtration ◽  
High Volume Hemofiltration ◽  
Anti Inflammatory ◽  
Sepsis And Septic Shock

Severe sepsis is one of the most significant challenges in critical care. Despite all the developments achieved in infectious diseases and critical care, along with numerous attempts to develop treatments, the mortality rate of severe sepsis and septic shock remains unacceptably high. The pathophysiology of severe sepsis and septic shock is only partially understood. Circulating pro-inflammatory and anti-inflammatory mediators appear to participate in the complex cascade of events which leads to deranged microcirculatory function, as we know from the peak concentration hypothesis. Therapeutic trials targeting single pro-inflammatory and anti-inflammatory mediators failed to demonstrate any benefit, suggesting that the unselective removal of different mediators may be a more appropriate approach. In severe sepsis several blood purification techniques, such as continuous hemofiltration (CVVH), high volume hemofiltration (HVHF), pulse high volume hemofiltration (HVHF), plasma filtration, plasma adsorption, coupled plasma filtration adsorption (CPFA), have been proposed but such techniques appear to have both theorical as well as practical limitations. Plasma Filtration Adsorption Dialysis (PFAD) is a new extracorporeal treatment which combines different principles of blood purification in a single device. The core of this technique is a new dialyzer composed by three suitable compartments that provide specific functions. The association of multiple principles permits specific removal of molecules implicated in the pathophysiology of patient's disease and re-establishment of hydro-electrolyte, acid-base equilibrium, if renal dysfunction-failure is present. The final target of PFAD is to obtain complete purification by combining principles of physics and chemistry to remove hydrophilic and hydrophobic molecules with a very wide range of weights.

scholarly journals Systemic anticoagulation during continuous renal replacement therapy – practical aspects

2019 ◽  
Author(s):  
Dariusz Onichimowski ◽  
Joanna Maria Wolska ◽  
Radosław Borysiuk ◽  
Marcin Mieszkowski ◽  
Zuzanna Stępień ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Therapy ◽  
Blood Purification ◽  
Routine Practice ◽  
Research Papers ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Systemic Anticoagulation

Introduction: Extracorporeal blood purification techniques have become a well-established part of routine practice in intensive therapy units. Ensuring appropriate anticoagulation to prevent the clotting of the circuit is the major concern while applying these techniques. Aim: The aim of this paper is to present methods of systemic anticoagulation which are currently used in continuous extracorporeal blood purification techniques. Ma t e r i a l and me thods : This work is based on the available literature and the experience of the authors. Re sul t s and di s cus s ion: The prevention of clotting in the extracorporeal circuit may be achieved through regional or systemic anticoagulation. Systemic anticoagulation is usually achieved by administration of unfractionated heparin. The most common complications include bleeding; additionally, there is a risk of type II thrombocytopenia occurring. Systemic anticoagulation may also be provided through administration of low molecular weight heparins. Some research papers have discussed the use of thrombin antagonists (argatroban, bivalirudin) and heparinoids (danaparoid, fondaparinux), as well as platelet inhibitors as systemic anticoagulants. It is also possible to conduct extracorporeal blood purification without anticoagulation. C o n c l u s i o n s : The introduction of continuous extracorporeal blood purification techniques into everyday practice of intensive care units has brought many unquestioned benefits to the patients treated in this setting. On the other hand, it means that doctors need to show an in-depth knowledge of the anticoagulation methods. Despite the wider use of regional anticoagulation during continuous renal replacement therapy, systemic anticoagulation is still important. This is especially when therapies with high blood flow are performed and contraindications to citrate use are present.

Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb

2019 ◽  
Vol 49 (1-2) ◽  
pp. 107-113 ◽  
Author(s):  
Samuele Zuccari ◽  
Elisa Damiani ◽  
Roberta Domizi ◽  
Claudia Scorcella ◽  
Mario D’Arezzo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Plasma Levels ◽  
Significant Variation ◽  
Near Infrared ◽  
Venous Blood ◽  
Blood Purification ◽  
Sidestream Dark Field ◽  
Extracorporeal Blood Purification

Background: Extracorporeal blood purification therapies have been proposed as a strategy to remove inflammatory mediators during sepsis, thus improving outcome. Objectives: We aimed to evaluate changes in cytokines, haemodynamics and microcirculation during blood purification with Cytosorb adsorber in septic patients. Methods: Prospective observational study on critically ill adult patients with sepsis/septic shock underwent renal replacement therapy (RRT) for acute renal failure and haemoadsorption with Cytosorb as adjunctive therapy for 24 h. Measurements were taken at baseline, after 6 and 24 h: haemodynamic parameters, arterial and central venous blood gases, plasma levels of tumour necrosis factor alpha, interleukin (IL) 1-beta, IL-6, IL-8 and IL-10. The sublingual microcirculation was assessed with sidestream dark field videomicroscopy to evaluate the perfused vessel density (PVD) and microvascular flow quality. Tissue oxygenation and microvascular reactivity were assessed with thenar near infrared spectroscopy (NIRS) with a vascular occlusion test. Results: Nine patients; plasma levels of IL-8 decreased at 24 h (p < 0.05 versus 6 h); no significant variation was found for other cytokines. Haemodynamic remained stable throughout the observation. Microvascular perfusion improved over time, with an increase in PVDs at 6 and 24 h (from 13.9 [13.3–16.4] to 15.7 [15–17.3] and 17 [14.8–18.6] mm/mm2 respectively, p = 0.003) and total vessel densities at 24 h (14.9 [13.9–16.9] vs. 17.9 [15.3–20], p = 0.0015). No significant variation was detected in NIRS-derived parameters. The Sequential Organ Failure Assessment score decreased from 12 ± 3 to 10 ± 1 at 24 h (p = 0.039). Conclusions: In septic patients undergoing RRT, haemoadsorption with Cytosorb seems to determine a decreasing in plasma levels of IL-8, although levels of other cytokines did not vary significantly, and an improvement of microcirculation despite no significant variation in macro-haemodynamics.

Acute Renal Failure and Multiple Organ Dysfunction in the ICU: From Renal Replacement Therapy (RRT) to Multiple Organ Support Therapy (MOST)

2002 ◽  
Vol 25 (8) ◽  
pp. 733-747 ◽  
Author(s):  
C. Ronco ◽  
R. Bellomo
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Multiple Organ ◽  
Blood Purification ◽  
Organ Support ◽  
Extracorporeal Blood Purification ◽  
Renal Support ◽  
Single Organ

Renal replacement therapy (RRT) has evolved from the concept that we need to treat the dysfunction of a single organ (the kidney). As intensive care units have become more and more complex, it has become clear that the majority of patients with acute renal failure often have dysfunction of several other organs. In order to facilitate single organ support in this setting, continuous renal replacement therapy (CRRT) techniques have been developed. However, CRRT has opened the door to the concept that targeting renal support as the only goal of extracorporeal blood purification may be a simplistic view of our therapeutic aims. In this article we argue that it is now time to move from the simple goal of achieving adequate renal support. The proper goal of extracorporeal blood purification in ICU should be multi-organ support therapy (MOST). We explain why MOST represents the most logical future conceptual and practical evolution of CRRT and illustrates the biological rationale, supplying animal and clinical evidence that confirms the need to move rapidly in this direction theoretically, practically and technologically.

scholarly journals Dynamics of essential amino acids plasma levels in patients with sepsis treated by the extracorporeal blood purification methods

2020 ◽  
Vol 17 (1) ◽  
pp. 64-69
Author(s):  
R. E. Yakubtsevich ◽  
N. V. Belyavsky ◽  
A. A. Glazev ◽  
S. D. Klisa
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Plasma Levels ◽  
Essential Amino Acids ◽  
Blood Purification ◽  
Treatment Protocols ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Plasma Filtration ◽  
Sepsis Therapy

Extracorporeal blood purification (EBP) is one of the trends of effective sepsis therapy. Some disadvantages of this method such as a possible reduction of plasma levels of different important metabolites are described. It is known that sepsis disorders of amino acid metabolism are manifested in microcirculation interruptions, the decreased immune response and the increased mortality. The aim of the study is to investigate the EBP effect on the essential amino acid plasma levels in patients diagnosed with sepsis. We selected 38 patients diagnosed with sepsis. Standard treatment protocols of plasma filtration, hemofiltration, and hemadsorption with various sorbents were used. We revealed a significant decrease in the levels of valine, methionine, tryptophan, isoleucine, phenylalanine, leucine, and lysine in patients who underwent hemadsorption by the sorbent “Proteasosorb”. Hemadsorption by the sorbent “Proteasosorb” has the greatest effect on the levels of amino acids.

scholarly journals Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Andrea Berkes ◽  
Edit Szikszay ◽  
János Kappelmayer ◽  
Adrienne Kerényi ◽  
Tamás Szabó ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Inflammatory Mediators ◽  
Clinical Management ◽  
Toxic Shock Syndrome ◽  
Immune Modulation ◽  
Blood Purification ◽  
Toxic Shock ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification

Background. Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. Case Presentation. A 5-year-old girl with Down’s syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. Conclusion. The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed.

scholarly journals Approach to the Metabolic Implications of Peritoneal Dialysis in Acute Kidney Injury

2015 ◽  
Vol 35 (4) ◽  
pp. 397-405 ◽  
Author(s):  
Cassiana Regina Góes ◽  
Marina Nogueira Berbel ◽  
Andre Luis Balbi ◽  
Daniela Ponce
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
High Volume ◽  
Blood Purification ◽  
Nutrition Status ◽  
Protein Loss ◽  
Dialysis Dose ◽  
Metabolic Complications ◽  
Extracorporeal Blood Purification

During the 1970s and 1980s, peritoneal dialysis (PD) was widely accepted as the standard treatment for acute kidney injury (AKI). However, advances in the techniques of extra-corporeal blood purification gradually reduced its use, making PD an underused modality in this context. Although PD for AKI is an underutilized modality worldwide, it is frequently used in developing countries because of its lower cost and minimal infrastructure requirements. Recent studies have shown that PD administered continuously through a flexible catheter and cycler is an effective treatment in AKI because it ensures adequate fluid status and metabolic control. However, the use of PD in AKI has several limitations, such as the need for an intact peritoneal cavity and, in emergency situations such as severe fluid overload and severe hyperkalemia, an efficacy that is lower than that with extracorporeal blood purification techniques. Metabolic, infectious, and mechanical disorders related to PD are also limitations.Among the metabolic complications of PD are hyperglycemia, hypernatremia, protein loss into the dialysate, and hypercatabolism. Hyperglycemia is caused by the use of dialysate containing high concentrations of glucose. Hypernatremia is a result of short dialysate dwell times during the rapid exchanges of high-volume PD. Protein loss into the dialysate can reach 48 g daily, worsening the nutrition status of patients already depleted by AKI. Severe hypercatabolism caused by PD remains controversial and occurs because PD methods cannot provide an adequate dialysis dose for AKI patients.Few studies have assessed the metabolic implications of PD in AKI patients. Evaluation of these implications is relatively simple, imposes no additional costs, and can provide information about the severity of the disease. Evaluation could also guide the selection of therapeutic, dialytic, and nutrition measures, preventing metabolic complications. The present manuscript describes the metabolic implications of PD and reviews the literature on how to prevent metabolic complications.

Subarachnoid Hemorrhage and Extracorporeal Blood Purification with HA-380 and High-Volume Hemofiltration: A New Therapeutic Challenge at the Neurocritical Care Unit? A Case Report

2021 ◽  
pp. 1-4
Author(s):  
Gonzalo Ramírez-Guerrero ◽  
Rocio Oliva Alarcón ◽  
Francisco Villagrán Cortés ◽  
Vicente Torres Cifuentes ◽  
Romyna Baghetti Hernández ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurocritical Care ◽  
High Volume ◽  
Refractory Shock ◽  
Source Of Infection ◽  
Extracorporeal Blood Purification ◽  
Hemodynamic Deterioration ◽  
Management Of Complications ◽  
High Volume Hemofiltration ◽  
High Doses

We present the case of a patient with subarachnoid hemorrhage (SAH) secondary to a ruptured cerebral aneurysm and a refractory shock with high doses of vasopressors without a proven source of infection. This patient received therapy with high-volume hemofiltration plus adsorption, resolving the hemodynamic deterioration and with good neurological evolution. Our clinical case proposes that extracorporeal therapies may have a feasibility role in the management of complications of SAH.

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