Kogelmann Klaus, Scheller Morten, Drüner Matthias, Jarczak Dominik
Department of Anesthesiology and Intensive Care Medicine, Klinikum Emden, Emden, Germany.
Department of Intensive Care Medicine, University Hospital Hamburg, Hamburg, Germany.
J Intensive Care Soc. 2020 May;21(2):183-190. doi: 10.1177/1751143718818992. Epub 2019 Jan 8.
Acute respiratory distress syndrome in the context of severe sepsis and septic shock represents a serious clinical disorder. A recent case series in patients with septic shock and renal failure receiving hemoadsorption treatment showed rapid hemodynamic stabilization and increased survival, particularly in pneumonia patients and in those where therapy was started early. We hypothesized that patients suffering from pneumonia and refractory acute respiratory distress syndrome to the extent that they required extracorporeal membrane oxygenation support could possibly demonstrate the most pronounced benefit from the treatment.
We assessed the association of hemoadsorption treatment with hemodynamics, ventilation, and outcome variables in a set of patients with septic shock, acute respiratory distress syndrome, need for veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy.
Key observations include a significant stabilization in hemodynamics as evidenced by a marked decrease in catecholamine need, which was paralleled by a clear reduction in hyperlactatemia. Respiratory variables improved significantly. In addition, severity of illness and overall organ dysfunction showed a considerable decrease during the course of treatment. Observed mortality was approximately half as predicted by APACHE II. Treatment with CytoSorb was safe and well tolerated with no device-related adverse events.
This is the first case series reporting on outcome variables associated to CytoSorb therapy in critically ill patients with septic shock, acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy. Based on our observations in this small case series, CytoSorb might represent a potentially promising therapy option for patients with refractory extracorporeal membrane oxygenation-dependent acute respiratory distress syndrome in the context of septic shock.
严重脓毒症和脓毒性休克背景下的急性呼吸窘迫综合征是一种严重的临床病症。最近一项针对接受血液吸附治疗的脓毒性休克和肾衰竭患者的病例系列研究表明，血液动力学迅速稳定，生存率提高，尤其是肺炎患者以及早期开始治疗的患者。我们推测，患有肺炎且难治性急性呼吸窘迫综合征以至于需要体外膜肺氧合支持的患者可能从该治疗中获益最为显著。
我们评估了一组患有脓毒性休克、急性呼吸窘迫综合征、需要静脉 - 静脉体外膜肺氧合以及持续肾脏替代治疗的患者中血液吸附治疗与血液动力学、通气和结局变量之间的关联。
主要观察结果包括血液动力学显著稳定，表现为儿茶酚胺需求明显减少，同时高乳酸血症明显减轻。呼吸变量显著改善。此外，在治疗过程中疾病严重程度和整体器官功能障碍显著降低。观察到的死亡率约为急性生理与慢性健康状况评分系统（APACHE II）预测值的一半。使用CytoSorb进行治疗安全且耐受性良好，未发生与设备相关的不良事件。
这是首个报道CytoSorb治疗与脓毒性休克、急性呼吸窘迫综合征、静脉 - 静脉体外膜肺氧合以及持续肾脏替代治疗的危重症患者结局变量相关的病例系列研究。基于我们在这个小病例系列中的观察结果，对于脓毒性休克背景下难治性体外膜肺氧合依赖的急性呼吸窘迫综合征患者，CytoSorb可能是一种潜在的有前景的治疗选择。
