Đánh giá hiệu quả lọc máu hấp phụ cytokin trong điều trị bệnh nhân covid-19

TÓM TẮT Đặt vấn đề: Lọc máu hấp phụ được xem là một phương pháp điều trị ở bệnh nhân Covid-19 nặng do có khả năng loại bỏ cytokine viêm. Nghiên cứu này mục đích để đánh giá hiệu quả lọc máu hấp phụ theo phương thức lọc máu ngắt quãng (IHD) ở bệnh nhân Covid-19. Phương pháp nghiên cứu: Nghiên cứu can thiệp, thực hiện trên các bệnh nhân được chẩn đoán viêm phổi do Covid-19 mức độ nặng ở trung tâm hồi sức tích cực bệnh viện dã chiến số 14, thành phố Hồ Chí Minh. Bệnh nhân được điều trị với thuốc kháng virus, kháng sinh, kháng đông và corticoid và liệu pháp oxy và 3 lần lọc máu hấp phụ sử dụng máy lọc máu ngắt quãng. Các chỉ số lâm sàng và xét nghiệm được thu thập và so sánh ở thời điểm trước và sau lọc máu. Kết quả: Có 6 bệnh nhân nam và 4 bệnh nhân nữ ở độ tuổi trung bình 54,60 ± 14,00 điều trị lọc máu hấp phụ, có 7 bệnh nhân cải thiện và cai dần với liệu pháp oxy. Giá trị SpO2 tăng từ 92,00 ± 2,31% đến 94,40 ± 1,71% với p = 0,02. IL - 6 trong máu bệnh nhân giảm từ 110,80 ± 126,84 pg/mL xuống 26,55 ± 26,80 pg/ mL với p = 0,06, CRP giảm từ 139,90 ± 57,41mg/L xuống 56,10 ± 53,10mg/L với p = 0,03. Kết luận: Lọc máu hấp phụ có thể giúp cải thiện SpO2 và hỗ trợ cai liệu pháp oxy ở hầu hết bệnh nhân trong nhóm nghiên cứu. Tuy nhiên, trong tương lai cần có nghiên cứu đa trung tâm, có đối chứng trên nhiều bệnh nhân để có thể đánh giá chắc chắn hiệu quả lọc máu hấp phụ ở bệnh nhân Covid-19. ABSTRACT EFFECTIVENESS OF HEMOPERFUSION IN COID-19 PATIENTS Backgrounds: Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. This study aims to evaluate the effectiveness of hemoperfusion in coid-19 patients. Methods: This experimental research has been conducted on severe COVID-19 pneumonia patients who admitted in field hospital in Ho Chi Minh city, receiving antiviral, antibacterial drugs, anticoagulant drugs and steroid, and different modalities of respiratory treatments. No randomization and blindness were considered. All of the participants underwent three sessions of resin-directed hemoperfusion using intermittent hemodialysis machine. Results: Six men and four women with a mean age of 54.60 ± 14.00 years has been enrolled in the study, and seven of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after cytokine removal therapy. Mean SpO2 before the three session of hemoperfusion was 92.00 ± 2.31% and increased to 94.40 ± 1.71% after them (p = 0.02). Serum IL - 6 showed a reduction from 110.80 ± 126.84 pg/mL to 26.55 ± 26.80 pg/mL p = 0.06; and C-reactive protein decreased from 139.90 ± 57.41mg/L to 56.10 ± 53.10mg/L p = 0.03. Conclusions: Extracorporeal hemoadsorption using intermittent dialyisis machine could improve the general condition in most of recruited patients with severe coronavirus disease, however, large prospective multicenter trials in carefully selected patients are needed to definitely evaluate the efficacy of hemoperfusion in COVID-19 patients. Keywords: Intermittent dialyisis machine, hemoperfusion, COVID-19 pneumonia.

History of the research laboratory (medicinal and environmental toxicology) of the Military medical academy named after S.M. Kirov

This paper presents the history of the formation of the Research Department of the Experimental Medicine of the Research Center of the Military Medical Academy named after S.M. Kirov. The department is the only division of the academy that conducts experiments on animal models and field tests using laboratory animals in the interests of the Armed Forces of the Russian Federation. The paper also presents the main scientific achievements and development prospects of one of the three laboratories of the department Research Laboratory of Medicinal and Environmental Toxicology. In the direction of drug toxicology, the laboratory staff worked for 15 years in cooperation with the Scientific Center of the Russian Academy of Sciences (Pushchino) on the problems of perfluorocarbon-based blood substitutes. The results of the study helped deepen the understanding of the mechanisms of the physiological activity of perfluorocarbon emulsions and the expansion of the areas of clinical application of perftoran. The ecotoxicological direction of scientific research is represented by two large-scale cycles of scientific studies. The first was devoted to the medical support of oil refining to increase the protection of personnel who have been professionally exposed to toxic chemicals from the damage caused by chemical accidents. The second area of environmental research, which has been significantly updated in recent years, is devoted to the study of remote environmental and biomedical consequences of the use of chemical weapons by the US Army in the period from 1966 to 1972 in Vietnam. In recent years, the laboratory has focused on problems related to the search and development of new radiation countermeasure agents including biotechnological products and their compositions. Studies are also being conducted to improve the complex therapy of patients with sepsis, in which methods of extracorporeal blood purification are used in the treatment. These works are relevant for military and civilian health care and are performed in cooperation with the departments of the academy and several leading research organizations in St. Petersburg.

Use of extracorporeal blood purification therapy (ECBPT) as an adjuvant to high-dose corticosteroids in a severely ill COVID-19 patient with concomitant bacterial infection

COVID-19 presents with a spectrum of severity, ranging from asymptomatic or mild symptoms to those with acute respiratory distress syndrome. Corticosteroids are widely used for their efficacy in reducing inflammatory responses. However, its use may be limited to patients with immunosuppression. An adjunct therapy for cytokine storm in COVID-19 is extracorporeal blood purification therapies using high adsorptive filters, such as oXiris, to remove cytokines. We share our experience in using continuous renal replacement therapy with oXiris haemofilter as a temporising measure to high-dose corticosteroids in managing cytokine storm in a deteriorating COVID-19 patient with concomitant bacterial infection.

Application of combined hemadsorption with eculizumab as rescue treatment of a pediatric patient with multiple organ failure related to severe hemolytic uremic syndrome

Many different extracorporeal blood purification techniques have been proposed in critically ill adult patients with sepsis and sepsis-like syndromes. In this context, hemoperfusion devices such as CytoSorb have been recently approved for extracorporeal cytokine removal. In the neonatal and pediatric setting however, the application of this method brings with it various challenges including profound technical difficulties with data for its application in critically ill pediatric patients remaining sparse. We present a case of a 2-year-old female patient affected by severe Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome (STECHUS) admitted to our Intensive Care Unit (ICU) with anuria, hemodynamic instability and severe neurological deterioration. By using a combined “rescue” therapy regimen with hemodiafiltration, hemadsorption (CytoSorb), plasmapheresis (PEX) and Eculizumab, the patient could be successfully stabilized, accompanied by a control of the hyperinflammatory response and an improvement in the neurological condition, finally leading to recovery. In pediatric patient extracorporeal blood purification techniques might potentially represent a promising adjuvant therapeutic option for the complications related to hemolytic uremic syndrome and hyperinflammation, but further studies are needed.

Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: COMMENTARY

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the CON: 10.34067/KID.0007382020

Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: PRO

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the CON: 10.34067/KID.0007382020 and the COMMENTARY 10.34067/KID.0005242021