Augmented Adsorptive Blood Purification during Continuous Veno-Venous Haemodiafiltration in a Severe Septic, Acute Kidney Injury Patient: Use of oXiris®: A Single Centre Case Report

Abstract

The use of the oXiris® haemofilter during continuous veno-venous haemodiafiltration (CVVHDF) for acute kidney injury (AKI) and severe sepsis is not completely understood. Although this filter has in vitro adsorptive properties for blood-borne cytokines and other humoural mediators of sepsis, its clinical usefulness is uncertain. Given its inherent adsorptive limitation for septic mediators, we developed a CVVHDF protocol in which the oXiris haemofilter was electively changed every 12 h even though there was no clotting or adverse circuit pressures. Augmented filter membrane adsorption was conducted for 3 consecutive days. We treated a critically ill patient with severe sepsis secondary to a gram-negative bacterial infection and sepsis-associated acute kidney injury (SA- AKI) in this way. The patient required high-dose vasopressor support, required mechanical ventilation, had received 12 h of CVVHDF with conventional M100 haemofilter, was on broad spectrum antibiotics and other conventional intensive care unit (ICU) care, prior to institution of the frequent oXiris haemofilter change protocol. Following the start of elective 12 hourly oXiris filter change, the patient showed reduction in the need for vasopressor and by Day 4 of this SA- AKI frequent filter change protocol, vasopressor requirement ceased, he was extubated. He survived ICU and but not hospital stay. To this end, more clinical studies are needed.

The absorbing filter Oxiris in severe coronavirus disease 2019 patients: A case series

“…In this study, we observed a significant improvement of hemodynamics among hemodynamically instable patients after Oxiris‐CRRT, which has already been widely confirmed by domestic and foreign researchers 13,14,16‐18 . However, the mechanism remains unclear.…”

“…In this study, we observed a significant improvement of hemodynamics among hemodynamically instable patients after Oxiris-CRRT, which has already been widely confirmed by domestic and foreign researchers. 13,14,[16][17][18] However, the mechanism remains unclear. Researchers have found that the main manifestations of microcirculation disorder were leukocyte adhesion and plasma extravasation, which may explain the possible mechanism of shock in sepsis patients; namely, plasma extravasation caused a decrease in the effective circulation capacity.…”

Prescription of CRRT: a pathway to optimize therapy

“…In another recent case report, a critically ill patient with severe sepsis secondary to a Gram-negative bacterial infection and sepsis-associated AKI was treated with CVVHDF using the oXiris set electively changed every 12 h for 3 consecutive days. The patient, who required high-dose vasopressor support and mechanical ventilation, showed reduction in the need for vasopressor support-by day 4, vasopressor requirements ceased and extubation occurred [94]. Similar findings were documented in a French study involving 31 septic patients receiving oXiris-based CRRT between 2014 and 2019.…”

Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic

“…Certain filter membranes putatively aid immunoadsorption of cytokines. 15,16 It is unknown whether these would be beneficial in patients with COVID-19, and their use should be reserved for specific indications or clinical trials.…”