Träger Karl, Fritzler Daniel, Fischer Guenther, Schröder Janpeter, Skrabal Christian, Liebold Andreas, Reinelt Helmut
Department of Cardiac Anesthesiology, University Hospital Ulm, Ulm - Germany.
Clinic of Cardiothoracic and Vascular Surgery, University Hospital Ulm, Ulm - Germany.
Int J Artif Organs. 2016 May 16;39(3):141-6. doi: 10.5301/ijao.5000492. Epub 2016 Apr 25.
The use of cardiopulmonary bypass (CPB) in cardiothoracic surgery results in a well-known activation of the immunologic response. In some cases, however, this triggered immunologic response may be excessive, leading to a severe systemic inflammatory response syndrome (SIRS) and induced organ dysfunction. For example, patients frequently develop hemodynamic instability with hypotension and low systemic vascular resistance. To date, different therapeutic approaches, such as steroids, have been tried to control this maladaptive postoperative SIRS response, yet definitive proof of clinical efficacy is missing. A new cytokine adsorber device (CytoSorb; CytoSorbents) may be a useful approach to control hyperinflammatory systemic reactions by reducing a broad range of proinflammatory cytokines and other inflammatory mediators. This may, in turn, help to reestablish a physiologic immune response and help to restore deranged clinical parameters in these patients. In this retrospective case series study, we describe 16 cardiac surgery patients following prolonged CPB with post-CPB SIRS and subsequent acute kidney injury, who were then treated with hemoadsorption using CytoSorb in combination with continuous renal replacement therapy (CRRT). Treatment of patients with CytoSorb who presented with severe post-CPB SIRS resulted in a reduction of elevated cytokine levels, which was associated with a clear stabilization of deranged hemodynamic, metabolic, and organ function parameters. Treatment was well tolerated and safe, with no device-related adverse events occurring. CytoSorb therapy combined with CRRT is a potentially promising new treatment approach to achieve hemodynamic stability, cytokine reduction, and improved organ function in cardiac surgery patients who develop post-CPB SIRS.
在心胸外科手术中使用体外循环（CPB）会引发众所周知的免疫反应激活。然而，在某些情况下，这种触发的免疫反应可能会过度，导致严重的全身炎症反应综合征（SIRS）并诱发器官功能障碍。例如，患者经常会出现伴有低血压和低体循环血管阻力的血流动力学不稳定。迄今为止，已经尝试了不同的治疗方法，如类固醇，来控制这种适应性不良的术后SIRS反应，但仍缺乏临床疗效的确切证据。一种新型细胞因子吸附装置（CytoSorb；CytoSorbents公司）可能是通过减少多种促炎细胞因子和其他炎症介质来控制高炎症性全身反应的有用方法。这反过来可能有助于重建生理性免疫反应，并有助于恢复这些患者紊乱的临床参数。在这项回顾性病例系列研究中，我们描述了16例在长时间CPB后出现CPB后SIRS及随后急性肾损伤的心脏手术患者，他们随后接受了使用CytoSorb结合连续性肾脏替代疗法（CRRT）的血液吸附治疗。对出现严重CPB后SIRS的患者使用CytoSorb进行治疗，导致升高的细胞因子水平降低，这与紊乱的血流动力学、代谢和器官功能参数明显稳定相关。治疗耐受性良好且安全，未发生与装置相关的不良事件。CytoSorb疗法联合CRRT是一种潜在有前景的新治疗方法，可使发生CPB后SIRS的心脏手术患者实现血流动力学稳定、细胞因子减少和器官功能改善。
