Clinical Department of Anesthesiology and Intensive Care Medicine, University Hospital St. Pölten-Lilienfeld, St. Pölten, Austria.
Int J Artif Organs. 2021 Oct;44(10):694-702. doi: 10.1177/03913988211030517. Epub 2021 Jul 13.
Severe cases of the COVID-19 are often associated with the development of a fulminant sepsis-like state with a concomitant cytokine release syndrome. Recently, immunomodulating approaches to treat such a hyperinflammation have come into focus, including the use of new extracorporeal organ support therapies such as CytoSorb hemoadsorption designed to remove cytokines and other circulating mediators from blood.
Thirteen critically ill COVID-19 patients with ARDS who received either ECMO therapy and/or CRRT with concomitant multiple organ failure were included. Hemoadsorption therapy was initiated once the patient had established-or was at high risk of developing-a hyperinflammatory state with marked hemodynamic instability or progressive lung failure. Levels of inflammatory markers, vasopressor requirements, oxygenation, and ventilation parameters were measured, as well as clinically relevant outcome measures.
Combined therapy was associated with a significant reduction in inflammatory mediators, hemodynamic stabilization with a concomitant decrease in requirements for vasoactive substances, and a pronounced improvement in lung function and the need for ventilatory support. Treatment appeared safe and well-tolerated.
In this case series of SARS-CoV-2 infected patients admitted to the intensive care unit with ARDS, we report effective interleukin (IL)-6 removal, reduced norepinephrine requirement, and improved lung function while receiving adjuvant, extracorporeal hemoadsorption therapy in the context of a multimodal treatment approach. The presented protocol for CytoSorb initiation may be a good foundation for the development of further prospective studies in the field and may eventually also be applied to other forms of hyperinflammatory ARDS.
COVID-19 的严重病例常伴有暴发性类似脓毒症的状态以及伴随的细胞因子释放综合征。最近，针对这种过度炎症的免疫调节治疗方法成为焦点，包括使用新型体外器官支持疗法，如设计用于从血液中去除细胞因子和其他循环介质的 CytoSorb 血液吸附。
纳入了 13 名患有 ARDS 的 COVID-19 危重症患者，他们接受 ECMO 治疗和/或伴有多器官衰竭的 CRRT。一旦患者出现明显的血流动力学不稳定或进行性肺衰竭的高炎症状态或有发展为高炎症状态的风险，就开始进行血液吸附治疗。测量炎症标志物、血管加压药需求、氧合和通气参数以及临床相关的预后指标。
联合治疗与炎症介质的显著减少相关，伴有血流动力学的稳定以及血管活性物质需求的降低，肺功能和通气支持需求明显改善。治疗似乎是安全且耐受良好的。
在这项 SARS-CoV-2 感染患者的病例系列研究中，这些患者因 ARDS 入住重症监护病房，我们报告了有效的白细胞介素（IL）-6 去除、去甲肾上腺素需求减少和肺功能改善，同时在多模式治疗方法的背景下接受辅助性体外血液吸附治疗。CytoSorb 起始的方案可能为该领域进一步前瞻性研究的发展提供良好的基础，最终也可能应用于其他形式的过度炎症性 ARDS。
