Continuous Renal Replacement Therapy Using Membranes with Increased Adsorption Capacity in Patients with Septic Shock after Neurosurgical Interventions

Introduction. The combination of primary brain injury with cytokine storm and hemodynamic disturbance in septic shock leads to secondary brain damage and growing neurological deficit. Blood purification procedures can be considered as an additional option in the treatment of septic shock in this group of patients.Subjects and Methods. The study included 11 patients after neurosurgical interventions with septic shock and acute kidney injury who underwent continuous renal replacement therapy (CRRT) using membranes with increased adsorption capacity.Results. During CRRT there was a significant regression in severity of multiorgan dysfunction according to SOFA score, a decrease in the requirement for vasopressor support with norepinephrine, and a decrease in lactate blood level. In addition, after the end of the procedure, there was a significant decrease in procalcitonin blood level. Septic shock reversal was observed in 8/11 patients (72.7%). In 3/11 patients, neurological deficits regressed during the procedure.Conclusions. The results indicate the possibility of using CRRT with membranes with increased adsorption capacity in patients after neurosurgical interventions with septic shock. Changes in neurological status can be considered as an additional parameter for the effectiveness of therapy for septic shock in patients with primary brain injury.

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Septic shock after liver transplantation successfully treated with endotoxin and cytokine adsorption continuous renal replacement therapy: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060520940439 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094043

Author(s):

Yining Li ◽

Linshan Zhou ◽

Lingzhi Yang ◽

Fang Yuan

Keyword(s):

Septic Shock ◽

Liver Transplantation ◽

Renal Replacement Therapy ◽

Liver Failure ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Chronic Liver ◽

Inflammatory Factors ◽

Decompensated Cirrhosis ◽

Chronic Liver Failure

Endotoxins and cytokines play an important role in multiple organ failure pathogenesis in patients with severe Gram-negative bacterial infection. We present a clinical case where an oXiris hemofilter was used for continuous renal replacement therapy (CRRT) treatment in a patient with septic shock after liver transplantation. A 35-year-old man with a 20-year history of hepatitis B presented with jaundice, loss of appetite, and decreased urine output. He was diagnosed with decompensated cirrhosis with acute-on-chronic liver failure, and liver transplantation was indicated. The day after surgery, he developed hyperthermia, hypotension, anuria, and a progressive increase in blood inflammatory markers and creatinine. Combined with the donor source and blood culture results, septic shock after transplantation was considered. The patient was immediately treated with endotoxin and cytokine adsorption CRRT (oXiris hemofilter) with tigecycline, caspofungin, and ganciclovir as anti-infectives. After 48 hours on CRRT, his blood pressure gradually stabilized, the CLIF Consortium Acute-on-Chronic Liver Failure score decreased from 63 to 43. Procalcitonin, endotoxin, and the inflammatory factors interleukin (IL)-6 and IL-10 also decreased gradually. The patient’s liver and kidney functions were completely restored. Our experience suggests that oXiris CRRT combined with antibacterial therapy is an effective treatment for septic shock after liver transplantation.

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