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J Artif Organs. 2017 Sep;20(3):252-259. doi: 10.1007/s10047-017-0967-4. Epub 2017 Jun 6.

Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study.

Author information

1
Department of Internal Medicine B (Cardiology, Pneumology, Medical Intensive Care Medicine), University Medical Center Greifswald, Ferdinand Sauerbruch Straße, 17475, Greifswald, Germany. sigrun.friesecke@uni-greifswald.de.
2
Department of Internal Medicine B (Cardiology, Pneumology, Medical Intensive Care Medicine), University Medical Center Greifswald, Ferdinand Sauerbruch Straße, 17475, Greifswald, Germany.
3
DZHK-German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.
4
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Sepsis is the most common cause of death in medical intensive care units (ICU). If sepsis progresses to refractory septic shock, mortality may reach 90-100% despite optimum current therapy. Extracorporeal cytokine adsorption in addition to regular therapy was studied prospectively in refractory septic shock patients on a medical ICU. Refractory shock was defined as increasing vasopressor dose required to maintain mean arterial blood pressure above 65 mmHg or increasing lactate levels despite protocol-guided shock therapy for 6 h. We analysed noradrenaline requirements after 6 and 12 h (primary endpoint), lactate clearance after 6 and 12 h, SOFA-scores in the first days and achievement of shock reversal (i.e., normalization of lactate concentrations and sustained discontinuation of vasopressors; secondary endpoints). Twenty consecutive patients with refractory septic shock were included; CytoSorb® treatment was started after 7.8 ± 3.7 h of shock therapy. Following the initiation of adsorption therapy, noradrenaline dose could be significantly reduced after 6 (-0.4 µg/kg/min; p = 0.03) and 12 h (-0.6 µg/kg/min; p = 0.001). Lactate clearance improved significantly. SOFA-scores on day 0, 1 and 2 remained unchanged. Shock reversal was achieved in 13 (65%) patients; 28-day survival was 45%. In severe septic shock unresponsive to standard treatment, haemodynamic stabilization was achieved using cytokine adsorption therapy, resulting in shock reversal in two-thirds of these patients. The study was registered in the German Register for Clinical Trials (DRKS) No. 00005149.

KEYWORDS:

Blood purification; CytoSorb®; Interleukin 6; Refractory septic shock; Septic shock therapy

PMID:
28589286
DOI:
10.1007/s10047-017-0967-4
[Indexed for MEDLINE]

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