Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
J Med Case Rep. 2023 Apr 8;17(1):156. doi: 10.1186/s13256-023-03851-y.
The use of hemoperfusion for cytokine removal and inflammatory mediators is increasingly intense, especially in coronavirus disease 2019 patients who are already known to the general public for having cytokine storms. However, we have known about these cytokine storms for a long time in the critical care world. One of the modalities to remove cytokines is to use filtration and adsorption techniques with continuous renal replacement therapy. The use of continuous renal replacement therapy is usually constrained by its very high cost compared with standard care, especially in Indonesia, where health costs are covered by national health insurance. In this case, we use hemodialysis and hemoperfusion, using a dialysis machine, which is more cost-effective and easy to use.
We used the Jafron HA330 cartridge, modified for the BBraun Dialog+ dialysis machine. This case report presents an 84-year-old Asian man with septic shock due to pneumonia, congestive heart failure, and acute chronic kidney disease accompanied by fluid overload. After undergoing hemodialysis and hemoperfusion separately, there was a gradual and significant clinical improvement. Clinical indicators, including the vasopressor inotropic score and infection markers, should all be considered when deciding whether to begin hemodialysis and hemoperfusion.
In general, using hemoperfusion to treat septic shock patients can reduce the length of stay in the intensive care unit, and morbidity and mortality.
血液灌流用于细胞因子去除和炎症介质的应用越来越广泛，尤其是在 2019 年冠状病毒病患者中，这些患者已经被公众所熟知，因为他们患有细胞因子风暴。然而，在重症监护领域，我们已经了解这些细胞因子风暴很长时间了。去除细胞因子的一种方法是使用连续肾脏替代治疗的过滤和吸附技术。与标准治疗相比，连续肾脏替代治疗的使用通常受到其非常高的成本的限制，特别是在印度尼西亚，那里的医疗费用由国家健康保险覆盖。在这种情况下，我们使用血液透析和血液灌流，使用透析机，这种方法更具成本效益，也更容易使用。
我们使用了 Jafron HA330 试剂盒，并对 BBraun Dialog+透析机进行了改装。本病例报告介绍了一位 84 岁的亚洲男性，因肺炎、充血性心力衰竭和急性慢性肾脏疾病伴体液超负荷而发生感染性休克。在分别进行血液透析和血液灌流后，患者的临床状况逐渐显著改善。在决定是否开始进行血液透析和血液灌流时，应考虑临床指标，包括升压药正性肌力评分和感染标志物。
总的来说，使用血液灌流治疗感染性休克患者可以降低重症监护病房的住院时间以及发病率和死亡率。
