Mehta Yatin, Ansari Abdul Samad, Mandal Amit Kumar, Chatterjee Dipanjan, Sharma Gauri Shankar, Sathe Prachee, Umraniya Purvesh V, Paul Rajib, Gupta Sachin, Singh Vinod, Singh Yogendra Pal
Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurgaon 122001, Haryana, India.
Department of Critical Care, Nanavati Max Super Specialty Hospital, Mumbai 400065, India.
World J Crit Care Med. 2024 Mar 9;13(1):89026. doi: 10.5492/wjccm.v13.i1.89026.
Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters. Despite standard therapy, the outcomes are poor. Newer adjuvant therapy, such as CytoSorb extracorporeal haemoadsorption device, has been investigated and shown promising outcome. However, there is a lack of some guidance to make clinical decisions on the use of CytoSorb haemoadsorption as an adjuvant therapy in septic shock in Indian Setting. Therefore, this expert consensus was formulated.
To formulate/establish specific consensus statements on the use of CytoSorb haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.
We performed a comprehensive literature on CytoSorb haemoadsorption in sepsis, septic shock in PubMed selecting papers published between January 2011 and March 2023 2021 in English language. The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps. Using a modified Delphi approach combining evidence appraisal and expert opinion, the following topics related to CytoSorb in septic shock were addressed: need for adjuvant therapy, initiation timeline, need for Interleukin -6 levels, duration of therapy, change of adsorbers, safety, prerequisite condition, efficacy endpoints and management flowchart. Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question.
Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. All 11 experts in the consensus group (100%) participated in the first, second and third round of voting. After three iterative voting rounds and adapting two statements, consensus was achieved on nine statements out of nine statements. The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb for all indications in the open-ended question (Q10) focusing on "future recommendations for CytoSorb therapy".
This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.
感染性休克是脓毒症的一种严重形式，其特征为循环和细胞代谢参数恶化。尽管采用了标准治疗，但预后仍较差。新型辅助治疗，如CytoSorb体外血液吸附装置，已得到研究并显示出有前景的结果。然而，在印度背景下，对于在感染性休克中使用CytoSorb血液吸附作为辅助治疗进行临床决策缺乏一些指导。因此，制定了本专家共识。
基于现有最佳证据并结合印度实际情况，制定/确立关于使用CytoSorb血液吸附治疗的具体共识声明。
我们在PubMed上对2011年1月至2023年3月（原文此处有误，应为2021年）发表的关于CytoSorb在脓毒症、感染性休克中的血液吸附的英文文献进行了全面检索。基于总结的文献分析和知识空白的识别，制定了共识文件的声明。采用结合证据评估和专家意见的改良德尔菲法，探讨了以下与感染性休克中CytoSorb相关的主题：辅助治疗的必要性、开始时间、白细胞介素-6水平的需求、治疗持续时间、吸附器更换、安全性、先决条件、疗效终点和管理流程图。来自重症监护、急诊医学和重症护理的11名专家成员参与并对9项声明和1个开放式问题进行了投票。
来自重症监护、急诊医学和重症护理的11名专家成员参与并对9项声明和1个开放式问题进行了投票。共识小组的所有11名专家（100%）参与了第一轮、第二轮和第三轮投票。经过三轮迭代投票并调整了两项声明后，9项声明中有9项达成了共识。共识专家小组还认识到有必要成立一个协会或学会，该协会或学会可以在聚焦“CytoSorb治疗的未来建议”的开放式问题（问题10）中对CytoSorb在所有适应症中的使用进行登记。
这份印度视角的共识声明支持并为在感染性休克患者中使用CytoSorb血液吸附作为辅助治疗以实现最佳结果提供了指导。
