Dimski Thomas, Brandenburger Timo, Slowinski Torsten, Kindgen-Milles Detlef
Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Department of Nephrology, University Hospital Charité, Berlin, Germany.
Int J Artif Organs. 2020 Jan;43(1):10-16. doi: 10.1177/0391398819866459. Epub 2019 Aug 3.
Septic shock is characterized by severe metabolic and hemodynamic alterations. It is often accompanied by acute kidney injury. A new adjunct treatment is hemoadsorption using a cytokine adsorber in line with continuous veno-venous renal replacement therapy. We studied the feasibility, efficacy, and safety of cytokine adsorption with citrate-anticoagulated continuous veno-venous hemodialysis (regional citrate anticoagulation-continuous veno-venous hemodialysis).
In 11 patients with septic shock and acute kidney injury stage 3, we studied 12 cycles of cytokine adsorption and regional citrate anticoagulation-continuous veno-venous hemodialysis. We monitored parameters of citrate anticoagulation, circuit lifetime, laboratory parameters, hemodynamics, and vasopressor demand.
Ten out of 12 adsorber/continuous veno-venous hemodialysis circuits reached the target lifetime of 24 h for the adsorber. One system clotted and one was stopped for non-device-related reasons. Nine of the remaining continuous renal replacement therapy circuits reached 72 h lifetime. With default settings for regional citrate anticoagulation, serum ionized calcium and pH were in the normal range. Urea and creatinine were reduced significantly, and norepinephrine dose decreased from 0.47 (±0.09) to 0.16 (±0.04) µg/kg/min ( = 0.016) after 24 h.
We show that combined cytokine adsorption/continuous veno-venous hemodialysis is effective to control pH, to reduce urea and creatinine, and to improve hemodynamics by reducing norepinephrine doses in patients with septic shock. It can be applied safely with standard settings of regional citrate anticoagulation rendering sufficiently long filter lifetimes for the adsorber and the continuous veno-venous hemodialysis circuit. Further studies are on the way to investigate whether these effects translate into improved outcomes in septic shock patients.
感染性休克的特征是严重的代谢和血流动力学改变。它常伴有急性肾损伤。一种新的辅助治疗方法是在持续静脉-静脉肾脏替代治疗中使用细胞因子吸附器进行血液吸附。我们研究了使用柠檬酸盐抗凝的持续静脉-静脉血液透析（局部柠檬酸盐抗凝-持续静脉-静脉血液透析）进行细胞因子吸附的可行性、有效性和安全性。
在11例感染性休克和急性肾损伤3期患者中，我们研究了12个周期的细胞因子吸附和局部柠檬酸盐抗凝-持续静脉-静脉血液透析。我们监测了柠檬酸盐抗凝参数、回路使用寿命、实验室参数、血流动力学和血管升压药需求。
12个吸附器/持续静脉-静脉血液透析回路中有10个达到了吸附器24小时的目标使用寿命。一个系统发生凝血，一个因非设备相关原因停止使用。其余9个持续肾脏替代治疗回路达到了72小时的使用寿命。在局部柠檬酸盐抗凝的默认设置下，血清离子钙和pH值在正常范围内。尿素和肌酐显著降低，24小时后去甲肾上腺素剂量从0.47（±0.09）降至0.16（±0.04）μg/kg/min（ = 0.016）。
我们表明，联合细胞因子吸附/持续静脉-静脉血液透析对于控制pH值、降低尿素和肌酐以及通过降低感染性休克患者的去甲肾上腺素剂量来改善血流动力学是有效的。它可以在局部柠檬酸盐抗凝的标准设置下安全应用，使吸附器和持续静脉-静脉血液透析回路具有足够长的滤器使用寿命。进一步的研究正在进行中，以调查这些效果是否能转化为感染性休克患者更好的预后。
