Impact of CytoSorb on kinetics of vancomycin and bivalirudin in critically ill patients

Scandroglio, Anna Mara; Pieri, Marina; Nardelli, Pasquale; Fominskiy, Evgeny; Calabrò, Maria Grazia; Melisurgo, Giulio; Ajello, Silvia; Pappalardo, Federico

doi:10.1111/aor.13952

Cited by 17 publications

(22 citation statements)

References 20 publications

(32 reference statements)

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“…Indeed, all patients were intubated and 53% were under VV ECMO due to refractory respiratory failure. In line with existing reports, 5 CytoSorb treatment was effective in improving several laboratory parameters (biliribubin above all) in our experience and no treatment-related adverse effects were recorded. The rationale for the use of CytoSorb in shock of several origin has been stressed in literature, with possible outcome benefits.…”

Section: Discussionsupporting

confidence: 92%

“…CytoSorb treatment (CytoSorbents Corporation, NJ, USA) is gaining increasing attention as a promising therapeutic tool in several acute care settings, [3][4][5] alone or in combination with other extracorporeal devices. 4,5 Following our previous experience with cytosorb treatment in intensive care unit patients, 4,5 we decided to use CytoSorb therapy in patients critically ill due to SARS-CoV-2 syndrome.…”

Section: Introductionmentioning

confidence: 99%

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CytoSorb purification in critically ill SARS-CoV-2 patients

et al. 2021

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Objective: To describe the experience with CytoSorb treatment in patients with refractory acute respiratory distress syndrome (ARDS) following SARS-CoV-2 infection. Methods: Retrospective observational study on 15 patients treated in a University Hospital. Results: All patients were male, with a mean age of 55 ± 14 years; eight patients (53%) were on venovenous extracorporeal membrane oxygenation (VV ECMO) due to refractory ARDS and all (100%) under mechanical ventilation at the time of CytoSorb use. We observed reduction in the level of C reactive protein (−52%, p = 0.002), total bilirubin (−46%, p = 0.03), direct bilirubin (−50%, p = 0.02), and D-dimers (−39%, p = 0.04) during CytoSorb treatment and a trend toward reduction in lactate dehydrogenase (−20%, p = 0.2), creatine phosphokinase (−38%, p = 0.1), and fibrinogen (−15%, p = 0.07). Eight patients died (53%) and seven (47%) were discharged from the ICU, of which five had recovery of the native lung function and two were successfully bridged to lung transplantation on VV ECMO support. No difference between survivors and non-survivors was present at baseline. Patients received three CytoSorb cycles on average: mean duration of CytoSorb cycle was 17 h 21 min, but premature circuit clotting despite appropriate level of systemic anticoagulation was frequently observed. Conclusions: CytoSorb treatment was effective in improving several laboratory parameters and inflammation in our experience and no treatment-related adverse effects were recorded. In the light of the unique pathophysiology of SARS-CoV-2 infection, CytoSorb treatment is extremely promising, since it might both reduce inflammation and activation of coagulation.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

CytoSorb purification in critically ill SARS-CoV-2 patients

et al. 2021

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“…Besides the in vitro data, there is only limited clinical data: Dimski et al demonstrated a significant adsorption and a superiority of the continuous infusion in two patients with vancomycin therapy and simultaneous CytoSorb ® application [ 19 ]. Scandroglio et al retrospectively showed an increased daily vancomycin dose requirement of about 500 mg in 89 critically ill patients [ 20 ]. Unfortunately, no population pharmacokinetic approach was applied in either study, so that a quantitative evaluation and comparability to our study is not possible without restrictions.…”

Section: Discussionmentioning

confidence: 99%

“…Of particular interest is the interaction between CytoSorb ® and vancomycin. However, there is a lack of reliable clinical data supporting the adsorption of vancomycin by CytoSorb® [ 19 , 20 ]. As a consequence, intensified TDM of antibiotics was recommended during the use of CytoSorb ® , although this service is sometimes not available, especially during weekends [ 4 , 11 , 17 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Does the cytokine adsorber CytoSorb® reduce vancomycin exposure in critically ill patients with sepsis or septic shock? a prospective observational study

Scharf

Weinelt

Schroeder

et al. 2022

Ann. Intensive Care

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Background Hemadsorption of cytokines is used in critically ill patients with sepsis or septic shock. Concerns have been raised that the cytokine adsorber CytoSorb® unintentionally adsorbs vancomycin. This study aimed to quantify vancomycin elimination by CytoSorb®. Methods Critically ill patients with sepsis or septic shock receiving continuous renal replacement therapy and CytoSorb® treatment during a prospective observational study were included in the analysis. Vancomycin pharmacokinetics was characterized using population pharmacokinetic modeling. Adsorption of vancomycin by the CytoSorb® was investigated as linear or saturable process. The final model was used to derive dosing recommendations based on stochastic simulations. Results 20 CytoSorb® treatments in 7 patients (160 serum samples/24 during CytoSorb®-treatment, all continuous infusion) were included in the study. A classical one-compartment model, including effluent flow rate of the continuous hemodialysis as linear covariate on clearance, best described the measured concentrations (without CytoSorb®). Significant adsorption with a linear decrease during CytoSorb® treatment was identified (p < 0.0001) and revealed a maximum increase in vancomycin clearance of 291% (initially after CytoSorb® installation) and a maximum adsorption capacity of 572 mg. For a representative patient of our cohort a reduction of the area under the curve (AUC) by 93 mg/L*24 h during CytoSorb® treatment was observed. The additional administration of 500 mg vancomycin over 2 h during CytoSorb® attenuated the effect and revealed a negligible reduction of the AUC by 4 mg/L*24 h. Conclusion We recommend the infusion of 500 mg vancomycin over 2 h during CytoSorb® treatment to avoid subtherapeutic concentrations. Trial registration NCT03985605. Registered 14 June 2019, https://clinicaltrials.gov/ct2/show/NCT03985605

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“…Its effects are wide and can be more properly assessed in terms of shock control (eg, reduction of inotropic requirements and shock laboratory parameters). 3 Moreover, patients on ECMO rarely benefit from or are rarely harmed by a single treatment: outcome is the result of comprehensive intensive management, by which the strategy of therapy is supported by mechanical circulatory support and associated devices. The reported causes of death reflect the importance and outcome of intensive care in general (including more than 6 L of fluids per patient) rather than device-related thromboembolic complications.…”

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confidence: 99%