Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study

<b><i>Introduction:</i></b> Coronavirus disease 2019 (COVID-19) is characterized by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and with critical cases progressing to acute respiratory distress syndrome. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation. With this work, we evaluated the longitudinal changes of systemic inflammatory markers in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) haemofilter. <b><i>Methods:</i></b> We performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing haemofilter (CAH) according to local practice; we visualize longitudinal results of biochemical, inflammatory, blood gas, and vital sign parameters focussing on systemic levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin. <b><i>Results:</i></b> All patients were treated with ≥1 cycle extracorporeal continuous venovenous haemofiltration (CVVH) with CAH; of these, 30 severe patients received CVVH-CAH within 4–12 h of admission after recognizing a hyper-inflammatory state. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and were placed on EBP during hospitalization. The treatment was associated with a reduction of ferritin, CRP, fibrinogen, several inflammatory markers, and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3%. <b><i>Conclusion:</i></b> EBP with CAH was associated with a decrease in CRP, and control of IL-6 and procalcitonin.

Haemoadsorption by CytoSorb® in patients with acute liver failure: A case series

Acute liver failure (ALF) is a life-threatening disease associated with multi-organ failure and increased mortality. Severe inflammation is now considered the main pathophysiological mechanism for organ dysfunction, thus rebalancing pro- and anti- inflammatory cytokines may improve liver function and outcome. The aim of this study was to assess the clinical effects of a haemoadsorption column on biochemical parameters in patients with ALF. We prospectively included 28 patients with ALF who were treated with three consecutive sessions of continuous venovenous haemofiltration in combination with CytoSorb®. Our results show an improvement in liver functional tests and a decrease in Creactive protein. Thrombocytopenia remains one of the most important side effects of this treatment and careful consideration should be made before initiation of treatment.

Comparison of renal replacement therapy and renal recovery before and during the COVID-19 pandemic- A single centre observational study

Background: To compare differences in indications, management, complications and outcomes of renal replacement therapy (RRT) in COVID-19 patients compared to non-COVID critically ill patients.Methods: We conducted a retrospective observational single centre cohort study in UK. Patients with COVID-19 requiring RRT, compared to consecutive, non-COVID-19 ICU patients requiring RRTResults: Of 154 COVID-19 patients, 47 (30.5%) received continuous venovenous haemofiltration (CVVHF), all of whom required mechanical ventilation and vasopressor support. The requirement for RRT was related to fluid balance rather than azotaemia. Compared to 36 non-COVID-19 patients, those with COVID-19 were younger with a lower serum creatinine on hospital admission, and lesser degrees of metabolic acidosis and lactataemia before initiation of RRT. In addition, the rate of haemofilter circuit clotting was higher and duration of RRT requirement was longer. However, despite lower CVVHF exchange rates with higher serum creatinine levels following RRT initiation in the COVID-19 patients, metabolic abnormalities were corrected. Hospital mortality was 60% among COVID-19 patients requiring RRT, compared to 67% in non-COVID patients (p=0.508), and renal recovery among survivors was similar.Conclusion: The metabolic phenotype in COVID-19 patients requiring RRT differs from non-COVID-19 patients, although outcomes (mortality and renal recovery) are similar.

Critical care

Critical care medicine is the specialty providing organ support to acutely unwell patients, and overlaps with anaesthetics, acute medicine, surgery, and emergency medicine. Patients are usually managed on the intensive care unit (ICU) or high dependency unit and require organ support in the form of intubation/ventilation/sedation, circulatory support (inotropes/vasopressors), renal replacement therapy (usually continuous venovenous haemofiltration), and nutrition. Common reasons for ICU admission include sepsis, complex surgery, respiratory disease, metabolic disturbance (such as diabetic ketoacidosis), head injury or reduced conscious level, and following cardiac arrest. A standardized approach to the evaluation of critically ill patients is outlined, as well as management of sepsis, acute asthma, and head injury. Principles of sedation, intubation, and ventilation/respiratory support are covered, as well as renal replacement therapy. The role of indwelling devices such as arterial lines and central venous catheters is also summarized.