Preliminary Report regarding the Use of Selective Sorbents in Complex Cardiac Surgery Patients with Extensive Sepsis and Prolonged Intensive Care Stay

Yaroustovsky, M.B.; Abramyan, Marina; Popok, Z V; Nazarova, E I; Stupchenko, O S; Popov, D. A.; Plushch, M.; Samsonova, N. N.

doi:10.1159/000231988

Cited by 38 publications

(34 citation statements)

References 50 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Analogous effects are described in other papers on the use of haemoperfusion on PMX-immobilised cartridge [19,20], as well as those on the use of ultrapermeable membranes in the intensive care of sepsis [12,14,25]. A number of authors have reported positive changes in haemodynamics accompanied by a statistically significant reduction of the inotrope dosage [21,26].…”

Section: Discussionsupporting

confidence: 54%

“…Targeted LPS adsorption haemodialysis (HD) with high cut-off membranes (EMiC2) has been effective in patients with sepsis [11,12,15,18,19,20,21]. However, there are no current publications on the combined use of extracorporeal approaches for simultaneous endotoxin elimination and lowering of the peak concentrations of inflammatory mediators.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Combined Extracorporeal Therapy for Severe Sepsis in Patients after Cardiac Surgery

Yaroustovsky¹,

Abramyan²,

Кротенко³

et al. 2014

Blood Purif

Self Cite

View full text Add to dashboard Cite

Introduction: Sepsis still represents an obstacle in modern medicine. The aim of this study was to evaluate the effectiveness and safety of the combined use of lipopolysaccharide adsorption and haemodialysis (HD) with high cut-off haemofilters as part of the complex intensive care of patients with severe sepsis after cardiac surgery. Methods: The study group included 26 patients, 57 (48-62) years of age, with severe sepsis. The inclusion criteria were clinical signs of severe sepsis (systemic inflammatory response syndrome + infection site + failure of two or more organs) together with endotoxin activity assay (EAA) ≥0.6 and procalcitonin (PCT) levels ≥2 ng/ml. Antimicrobial therapy was initiated in the first hour after the diagnosis of severe sepsis and extracorporeal therapy was initiated within 24 h. All of the patients in the study group received standard therapy. Additionally, they received treatment consisting of two LPS adsorption procedures and HD procedures with high cut-off haemofilters in a single circuit. For the control group, 30 comparable patients, 57 (51-61) years of age, were selected and received only standard therapy. Results: After the last HD procedure within the extracorporeal therapy, we noted an increase in the mean arterial pressure from 76 to 90 mm Hg, p < 0.01, and oxygenation index (from 226 to 291, p < 0.02), in addition to decreases in the LPS concentration according to EAA (from 0.73 to 0.59, p < 0.01) and the Limulus amebocyte lysate test (from 1.44 to 0.36 IU/ml, p < 0.01); PCT falls from 8.19 to 2.44 ng/ml, p < 0.01, and sepsis-related organ failure assessment scores decreases from 13 to 10, p = 0.007. When we compared the data between the study group the day after the procedures and the control group 3 days after the start of intensive care, we discovered that there were statistically significant differences in mean arterial pressure (90 vs. 81 mm Hg, p = 0.0004), oxygenation index (291 vs. 229, p = 0.01), and EAA levels (0.59 vs. 0.67, p = 0.05). Differences in the PCT were not significant (2.44 vs. 3.41, p = 0.15). The 28-day survival rate in the study group was higher than that in the control group (65.4 vs. 33.3%, p = 0.03). Conclusion: The combined use of LPS adsorption and HD with high cut-off haemofilters in conjunction with standard therapy is a safe, effective method for treating patients who have severe sepsis.

show abstract

Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Combined Extracorporeal Therapy for Severe Sepsis in Patients after Cardiac Surgery

Yaroustovsky¹,

Abramyan²,

Кротенко³

et al. 2014

Blood Purif

Self Cite

View full text Add to dashboard Cite

show abstract

“…Clinical experience with this device is scarce, and is limited mainly to case reports and case series. [32][33][34] In general, these case series report a shorter vasopressor infusion duration in adsorber-treated patients compared with controls. Only one underpowered RCT has been published by local investigators.…”

Section: Alteco Lipopolysaccharide Adsorbermentioning

confidence: 78%

Extracorporeal blood purification for sepsis

Shum

Chan

2016

Hong Kong Med J

View full text Add to dashboard Cite

It has been speculated that extracorporeal blood purification therapies might improve the clinical outcome for patients with severe sepsis, with or without acute kidney injury, since the removal of inflammatory mediators and/or bacterial toxins from circulation could modulate the inflammatory responses that result in organ damage. Despite initial enthusiasm based on promising preliminary results, subsequent investigations did not show sustainable survival benefit. We review the principles and development of blood purification techniques for sepsis and septic acute kidney injury.

show abstract

“…The procedures of LPS-adsorption were conducted according to the previously described protocol [11,12], using a MultiFiltrate machine (Fresenius, Germany). Before selective haemoperfusion, the extracorporeal circuit was washed with 4,000 ml of 0.9% NaCl solution and then with 500 ml of physiological saline supplemented with 2,500 IU of heparin.…”

Section: Methodsmentioning

confidence: 99%

A Pilot Study of Selective Lipopolysaccharide Adsorption and Coupled Plasma Filtration and Adsorption in Adult Patients with Severe Sepsis

Yaroustovsky¹,

Abramyan²,

Кротенко³

et al. 2015

Blood Purif

View full text Add to dashboard Cite

Aim: To evaluate the safety and effectiveness of combined extracorporeal therapy in patients with severe sepsis after cardiac surgery. Materials and Methods: Twenty patients received combined extracorporeal therapy (LPS-adsorption with Toraymyxin columns + CPFA). The inclusion criteria were clinical signs of severe sepsis, EAA = 0.6, and PCT >2 ng/ml. 20 comparable patients in the control group received only standard therapy. Results: Each patient in the study group received 2 daily treatments of combined extracorporeal therapy. In contrast to controls, we noted an increase in the values of MAP from 73 to 82 mm Hg, (p < 0.001) and the mean oxygenation index (from 180 to 246, p < 0.001), decrease of EAA from 0.77 to 0.55, p < 0.001, and PCT (from 6.23 to 2.83 ng/ml, p < 0.001). The 28-day survival rate was 65 and 35% in the study and control groups respectively, p = 0.11. Conclusion: The combined use of LPS-adsorption and CPFA in a single circuit with standard therapy is a safe and possibly effective adjunctive method for treating severe sepsis.

show abstract

Preliminary Report regarding the Use of Selective Sorbents in Complex Cardiac Surgery Patients with Extensive Sepsis and Prolonged Intensive Care Stay

Cited by 38 publications

References 50 publications

Combined Extracorporeal Therapy for Severe Sepsis in Patients after Cardiac Surgery

Combined Extracorporeal Therapy for Severe Sepsis in Patients after Cardiac Surgery

Extracorporeal blood purification for sepsis

A Pilot Study of Selective Lipopolysaccharide Adsorption and Coupled Plasma Filtration and Adsorption in Adult Patients with Severe Sepsis

Contact Info

Product

Resources

About