Endotoxin Adsorption using Polymyxin B Immobilized Fiber Cartridges in Severe Sepsis Patients following Cardiac Surgery

Yaroustovsky, M.B.; Abramyan, Marina; Кротенко, Н. П.; Popov, D. A.; Plyushch, Marina; Popok, Z V

doi:10.5301/ijao.5000322

Cited by 15 publications

(9 citation statements)

References 29 publications

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“…Overall, this review concluded that selective LPS-adsorption was associated with improvements in clinical outcomes (significant increases in mean arterial blood pressure, + 19 mmHg; reductions in vasoactive dopamine/dobutamine dose, − 1.8 μg/kg/min; and increases in gas exchange, mean arterial partial pressure of oxygen/fraction of inspired oxygen ratio, + 32 units) and in mortality risk (risk ratio, 0.53; 95% CI, 0.43–0.65). More recently, improvements in hemodynamic indices and survival rates have also been shown following Toraymyxin hemoperfusion of patients with severe sepsis or septic shock in the randomized controlled EUPHAS trial vs conventional therapy [ 15 ], the EUPHAS 2 registry [ 16 ], and in a prospective study [ 17 ]. However, no improvement was seen in either mortality or organ failure with Toraymyxin in a study enrolling 243 patients from 18 French intensive care units [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

In vitro comparison of the adsorption of inflammatory mediators by blood purification devices

Malard

Lambert

Kellum

2018

ICMx

190

184

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BackgroundSeptic shock, a leading cause of acute kidney injury, induces release of pro-/anti-inflammatory mediators, leading to increased mortality and poor renal recovery. This is the first in vitro study directly comparing three single-use blood purification devices in terms of removing sepsis-associated mediators and endotoxins.MethodsIn vitro hemoperfusion was performed using oXiris®, CytoSorb®, and Toraymyxin®. Heparinized human plasma from healthy volunteers was pre-incubated with pathologic quantities of inflammatory mediators and filtered in a closed-loop circulation model for 2 h. For each device, the removal of 27 inflammatory mediators was measured over time. Endotoxin removal mediated by oXiris and Toraymyxin was assessed using hemoperfusion over 6 h.ResultsEndotoxin (lipopolysaccharide) removal was most rapid with Toraymyxin; mean adsorptive clearance over the first 30 min was ~ 20 ml/min vs ~ 8 ml/min with oXiris (p < 0.05). There was minimal endotoxin removal with CytoSorb (1 ml/min). At 120 min, there was no significant difference between the endotoxin removal rates using oXiris (mean ± standard deviation, 68.0 ± 4.4%) and Toraymyxin (83.4 ± 3.8%); both were significantly higher vs CytoSorb (− 6.3 ± 4.9%; p < 0.05). Total removal with oXiris was 6.9 μg vs 9.7 μg for Toraymyxin, where the total lipopolysaccharide quantity introduced was approximately 15.8 μg. Removal rates of pro-/anti-inflammatory cytokines and other inflammatory mediators were similar between oXiris and CytoSorb and were higher with CytoSorb and oXiris vs Toraymyxin. Granulocyte colony-stimulating factor was only effectively adsorbed by CytoSorb (99.4%). Differences were detected between the adsorption mechanism of the devices; binding to oXiris was mainly ionic, while CytoSorb was hydrophobic. No specific protein adsorption was found qualitatively with Toraymyxin.ConclusionsAdsorption rate kinetics varied for individual inflammatory mediators using the three blood purification devices. Mechanisms of adsorption differed between the devices. oXiris was the only device tested that showed both endotoxin and cytokine removal. oXiris showed similar endotoxin adsorption to Toraymyxin and similar adsorption to CytoSorb for the removal of other inflammatory mediators. Differences in device removal capacities could enable treatment to be more tailored to patients.Electronic supplementary materialThe online version of this article (10.1186/s40635-018-0177-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

In vitro comparison of the adsorption of inflammatory mediators by blood purification devices

Malard

Lambert

Kellum

2018

ICMx

190

184

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“…With respect to the application of extracorporeal approaches targeting pathogens, pathogen-associated molecular patterns, or endogenous mediators of inflammation in the circulation, their combination with appropriate diagnostic tools is therefore highly warranted. The application of PMX-DHP together with an endotoxin activity assay (80) is a first step in this respect, and other extracorporeal approaches targeting pathogens or inflammatory mediators in the circulation should be based on similar considerations, applying point-of-care diagnostic systems with minimal sample handling and short time-to-result to move toward personalised, biomarker-guided, adjunctive sepsis treatments.…”

Section: Patient Heterogeneity In Sepsis and The Need For A Theragnosmentioning

confidence: 99%

Mechanisms of Endothelial Activation in Sepsis and Cell Culture Models to Study the Heterogeneous Host Response

2017

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Sepsis is currently viewed as a fundamental disintegration of control functions from intracellular signalling to immunoregulatory and neuroendocrine mechanisms. The immediate threat in sepsis is invasive infection, and the need to activate immune defense mechanisms to clear the pathogen before irreparable damage occurs. In the process of pathogen elimination, however, the systemic host response to infection may cause collateral damage to the endothelium and may lead to the destruction of host tissues.A number of experimental models have been developed to monitor endothelial activation and to study endothelial dysfunction under septic conditions. Here, we review the application of these models to assess the highly variable host response in sepsis and to investigate the efficacy of adsorbent-based extracorporeal therapies. We also highlight the need for efficient diagnostic tools, which are indispensable to select patients who are likely to benefit from distinct adjunctive therapies.

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“…Bakulev NSPCCS in 2009-2016, showed the safety and efficacy of the combined therapies mentioned above. [53,54] We observed that the combination of LPS-adsorption and HDF filters with high cut-off EMiC2 membranes led to a 34% MAP increase [from 76 (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81) to 90 (85-102) mmHg, P < 0.001] with reduced vasopressor and inotropic support. The increase in MAP during LPS-adsorption with CPFA was 12% with the significant decrease in vasopressor support [the dose of noradrenaline was halved from 0.2 (0.15-0.3) to 0.1 (0.05-0.15) µg/kg/min, P = 0.024].…”

Section: Extracorporeal Blood Purification In Complex Intensive Theramentioning

confidence: 99%

“…[64][65][66][67] LPS-adsorption using Toraymyxin-PMX-20R Polymyxin B immobilized fiber cartridges was found to be effective, simultaneously acting through sorption and apheresis on bacterial endotoxin, systemic inflammatory mediators and activated immune cells. [59][60][61]68,69] CPFA performs an immunomodulatory role by acting on inflammatory mediators (interleukin-1β, -6, -8, -10, -18, tumor necrosis factor-α and others) via various mass transfer mechanisms such as diffusion, convection and adsorption. The advantages of CPFA include the passage of plasma (and not blood) through the sorption column, which increases the contact time with the sorption surface and improves the efficiency of the procedure.…”

Section: Extracorporeal Blood Purification In Complex Intensive Theramentioning

confidence: 99%

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

Yaroustovsky¹,

Abramyan²,

Komardina³

et al. 2017

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How to cite this article: Yaroustovsky M, Abramyan M, Komardina E, Nazarova H. Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery. Vessel Plus 2017;1:49-60.Extracorporeal blood purification is becoming increasingly important in intensive therapy for multiple organ dysfunction syndrome (MODS) and sepsis, considering all of their pathophysiological aspects. The results of treatment, particularly in children, considering their anatomical and physiological features, are related to the severity and progression of organ failure, the indications that are found, the choice of method, and the timely initiation of blood purification. Multiple organ support therapy is the aim of introducing and applying blood purification today. Various extracorporeal blood purification techniques directly affect the molecular and electrolyte composition of blood and influence all structures of the human body, which can allow us to correct, recover, replace and maintain homeostasis in MODS. The potential of new extracorporeal molecular technologies allows their successful use in severe cardiac and respiratory failure, acute kidney injury and hepatic dysfunction and in complex therapy for severe infections and sepsis and extreme metabolic violations. Adult and pediatric patients after cardiac surgery with cardiopulmonary bypass form a special cohort that often requires the application of various intra-and extracorporeal techniques due to the development of MODS, infections and sepsis in the postoperative period. Key words:Extracorporeal blood purification, acute kidney injury, acute liver failure, extracorporeal membrane oxygenation, sepsis, selective lipopolysaccharideadsorption, critical condition, cardiovascular surgery ABSTRACT Article history:

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Endotoxin Adsorption using Polymyxin B Immobilized Fiber Cartridges in Severe Sepsis Patients following Cardiac Surgery

Abstract: Selective LPS-adsorption is a safe and possibly effective adjunctive treatment method for severe sepsis patients.

Cited by 15 publications

References 29 publications

In vitro comparison of the adsorption of inflammatory mediators by blood purification devices

In vitro comparison of the adsorption of inflammatory mediators by blood purification devices

Mechanisms of Endothelial Activation in Sepsis and Cell Culture Models to Study the Heterogeneous Host Response

Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery

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