Kogelmann Klaus, Jarczak Dominik, Scheller Morten, Drüner Matthias
Department of Anaesthesiology and Intensive Care Medicine, Klinikum, Emden, Germany.
Department of Intensive Care Medicine, University Hospital Hamburg, Hamburg, Germany.
Crit Care. 2017 Mar 27;21(1):74. doi: 10.1186/s13054-017-1662-9.
Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis.
In the present case series, we evaluated the impact of a new hemoadsorption device (CytoSorb) used as adjunctive therapy, on hemodynamics and clinically relevant outcome parameters in 26 critically ill patients with septic shock and in need of renal replacement therapy.
We found that treatment of these patients with septic shock was associated with hemodynamic stabilization and a reduction in blood lactate levels. Actual mortality in the overall patient population was lower than mortality predicted by acute physiology and chronic health evaluation II (APACHE II). These effects seem to be more pronounced in patients in whom therapy started within 24 h of sepsis diagnosis, whereas a delay in the start of therapy was associated with a poor response to therapy in terms of reduction of catecholamine demand and survival. Moreover, from our patient population, medical patients seemed to benefit more than post-surgical patients in terms of survival. Treatment using the CytoSorb device was safe and well-tolerated with no device-related adverse events during or after the treatment sessions.
Hemoadsorption using CytoSorb resulted in rapid hemodynamic stabilization and increased survival, particularly in patients in whom therapy was started early. Given the positive clinical experience of this case series, randomized controlled trials are urgently needed to define the potential benefits of this new treatment option.
脓毒性休克被定义为由宿主对感染的失调反应引起的危及生命的器官功能障碍，是一种高度致命的病症，在重症患者中导致大量发病和死亡。脓毒症的标志之一是细胞因子和其他炎症介质的过度释放，导致难治性低血压、组织损伤、代谢性酸中毒并最终引发多器官功能衰竭。在此背景下，通过血液吸附减少细胞因子代表了一种血液净化的新概念，旨在减轻脓毒症早期释放的大量促炎和抗炎介质的全身水平。
在本病例系列中，我们评估了一种新型血液吸附装置（CytoSorb）作为辅助治疗，对26例患有脓毒性休克且需要肾脏替代治疗的重症患者的血流动力学和临床相关结局参数的影响。
我们发现，对这些脓毒性休克患者的治疗与血流动力学稳定和血乳酸水平降低相关。总体患者人群的实际死亡率低于急性生理学与慢性健康状况评估II（APACHE II）预测的死亡率。这些效应在脓毒症诊断后24小时内开始治疗的患者中似乎更为明显，而治疗开始延迟与在减少儿茶酚胺需求和生存方面对治疗的反应不佳相关。此外，在我们的患者人群中，内科患者在生存方面似乎比外科术后患者受益更多。使用CytoSorb装置进行治疗是安全的且耐受性良好，在治疗期间或之后未发生与装置相关的不良事件。
使用CytoSorb进行血液吸附可实现快速的血流动力学稳定并提高生存率，尤其是在早期开始治疗的患者中。鉴于该病例系列的积极临床经验，迫切需要进行随机对照试验以确定这种新治疗选择的潜在益处。
