Background: Septic shock is a leading cause of acute kidney injury (AKI). Endotoxins and cytokine levels are associated with the occurrence and severity of AKI, and different blood purification devices are available to remove them from circulation. One such device, oXiris, is a hollow-fibre purification filter that clears both endotoxins and cytokines. Due to limited evidence, clinical use of this device is not currently advocated in guidelines. However, clinics do regularly use this device, and there is a critical need for guidance on the application of it in sepsis with and without AKI. Method: A modified Delphi-based method was used to collate European experts’ views on the indication(s), initiation and discontinuation criteria and success measures for oXiris. Results: A panel of 14 participants was selected based on known clinical expertise in the areas of critical care and sepsis management, as well as their experience of using the oXiris blood purification device. The participants used different criteria to initiate treatment with oXiris in sepsis patients with and without AKI. Septic shock with AKI was the priority patient population, with oXiris used to rapidly improve haemodynamic parameters. Achieving haemodynamic stability within 72 h was a key factor for determining treatment success. Conclusion: In the absence of established guidelines, users of hollow-fibre purification devices such as oXiris may benefit from standardised approaches to selecting patients and initiating and terminating treatment, as well as measuring success. Further evidence in the form of randomised clinical trials is urgently required.
Sepsis is among the leading causes of mortality globally. Blood purification techniques are evolving in sepsis therapy, aiming at pathogenic antigens and host cytokines. The aim of this study was to determine whether continuous renal replacement therapy (CRRT) with modified AN69ST membrane, brand name oXiris, improves the clinical course of adult patients with septic shock. The study had a retrospective, longitudinal, propensity score matching (PSM) design with two groups: treatment — CRRT started with oXiris, control — used ST150 filters only. Data from 636 patients were analysed. The oXiris and control groups included 40 and 57 patients, respectively. PSM left 19 patients in each group. Ten of 19 patients died in the oXiris group. Survival, CRRT duration, intensive care unit or hospital length of stay did not differ between the groups. The oX-iris group had a tendency for lower mortality in Gram-negative infection cases, though not statistically significant. During the first 72h of CRRT, both groups had improvement in noradrenaline requirement, arterial pressure and blood lactate. However, with oXiris treatment, increase of arterial pressure (TA) was greater during CRRT during the first 24h and there was a more significant decrease of noradrenaline infusion and lactate during the first 72 h. We concluded that in septic shock early CRRT with oXiris may be beneficial and that there might be decreased hospital mortality in the case of Gram-negative infection. Further larger studies are required.
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