Elkhatib Wiaam Y, Saunders Hollie, Helgeson Scott A, Moss John E
Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States.
Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, United States.
Indian J Crit Care Med. 2021 Aug;25(8):939-941. doi: 10.5005/jp-journals-10071-23943.
A 66-year-old Caucasian male with a history of chronic myelomonocytic leukemia (CMML) developed fluid-unresponsive hypotension requiring initiation of four different maximum dosed vasopressors, steroids, and broad-spectrum antibiotics 4 hours following four-vessel coronary artery bypass grafting involving a 150-minute cardiac bypass. Placement of a Swanz-Ganz catheter showed a cardiac output of 7 L/minute with systemic vascular resistance of 571 dynes/sec/cm. Over 24 hours, three doses of tocilizumab (interleukin-6 inhibitor) every 8 hours were initiated, plus 250 mg methylprednisolone per 6 hours increment, and then daily thereafter. After the initial dose of tocilizumab, it was possible to wean vasoconstrictors. We have shown for the first time that therapy with tocilizumab is effective in reversing the hemodynamic instability associated with the significant systemic inflammatory response from the "double hit" of CMML and coronary artery bypass grafting with cardiopulmonary bypass as has previously been shown in cytokine release syndrome. Elkhatib WY, Saunders H, Helgeson SA, Moss JE. The Use of an Interleukin-6 Inhibitor in Vasoplegic Shock from Severe Systemic Inflammatory Response Syndrome: A Case Report. Indian J Crit Care Med 2021;25(8):939-941.
一名66岁的患有慢性粒单核细胞白血病（CMML）的白人男性，在进行了长达150分钟体外循环的四支血管冠状动脉搭桥术后4小时，出现了对液体无反应的低血压，需要开始使用四种不同的最大剂量血管加压药、类固醇和广谱抗生素。放置Swan-Ganz导管显示心输出量为7升/分钟，全身血管阻力为571达因/秒/厘米。在24小时内，每8小时开始使用三剂托珠单抗（白细胞介素-6抑制剂），每6小时增加250毫克甲泼尼龙，此后每天使用。在首次使用托珠单抗后，有可能逐渐减少血管收缩剂的用量。我们首次表明，托珠单抗治疗可有效逆转与CMML和冠状动脉搭桥术加体外循环的“双重打击”所导致的显著全身炎症反应相关的血流动力学不稳定，正如之前在细胞因子释放综合征中所显示的那样。埃尔卡提卜·WY、桑德斯·H、赫尔格森·SA、莫斯·JE。白细胞介素-6抑制剂在严重全身炎症反应综合征所致血管麻痹性休克中的应用：一例报告。《印度重症监护医学杂志》2021年；25(8):939 - 941。
