Sequential use of hemadsorption using Cytosorb® and Biosky® filter- technology in a COVID-19 patient suffering from severe ARDS

Mezger, Matthias; Eitel, Ingo; Ensminger, S. Allen; Pogorzalek, Dirk; Huang, Zhipan; Graf, Tobias

doi:10.21203/rs.3.rs-47352/v1

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Jafron HA showed in two clinical studies an improvement in uremic symptoms and pruritus score as well as a decrease in parathyroid hormone and calcium phosphate [26]. There is only 1 published case study on using Biosky MG in a patient with acute respiratory distress syndrome [27]. Unfortunately, the data available on the clinical benefit of adsorber-based methods are very limited.…”

Section: Discussionmentioning

confidence: 99%

“…Biosky MG is approved for the adsorption of medium-and largemolecular weight toxins and protein-bound toxins such as parathyroid hormone, β2M, leptin, HCY, interleukin 1β, and IL-6 in patients with terminal kidney failure. However, there is only one publication on the clinical use of this adsorber [27]. Cytosorb is approved for the adsorption of proinflammatory cytokines such as interleukin 1β, IL-6, and tumor necrosis factor α, and it is used to treat patients under acute inflammatory conditions such as sepsis, cardiac surgery, or organ transplantation [28][29][30].…”

Section: Extracorporeal Blood Purificationmentioning

confidence: 99%

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In vitro Removal of Protein-Bound Retention Solutes by Extracorporeal Blood Purification Procedures

Schildboeck,

Harm,

Hartmann

2024

Blood Purif

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When the kidneys or liver fail, toxic metabolites accumulate in the patient's blood, causing cardiovascular and neurotoxic complications and increased mortality. Conventional membrane-based extracorporeal blood purification procedures cannot remove these toxins efficiently. The aim of this in-vitro study was to determine whether commercial hemoperfusion adsorbers are suitable for removing protein-bound retention solutes from human plasma and whole blood as well as to compare the removal to conventional hemodialysis. For in-vitro testing of the removal of protein-bound substances, whole blood and plasma were spiked with the uremic retention solutes (homocysteine, hippuric acid, indoxyl sulfate, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid) and the toxins of liver failure (bilirubin, cholic acid, tryptophan, phenol). Subsequently, the protein binding of each retention solute was determined. The adsorption characteristics of the hemoperfusion adsorbers Jafron HA and Biosky MG, both approved for the adsorption of protein-bound uremic retention solutes and Cytosorb, an adsorber recommended for adsorption of cytokines, were tested by incubating them in spiked whole blood or plasma for one hour. Subsequently, the adsorption characteristics of the adsorbers were tested in a dynamic system. For this purpose, a six-hour in-vitro hemoperfusion treatment was compared with an equally long in-vitro hemodialysis treatment. Hippuric acid, homocysteine, Indoxyl Sulfate and Tryptophan were most effectively removed by hemodialysis. Bilirubin and Cholic Acid were removed best by hemoperfusion with Cytosorb. A treatment with Jafron HA and Biosky MG showed similar results for the adsorption of the tested retention solutes and were best for removing phenol. 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid could not be removed with any treatment method. A combination of hemodialysis with hemoperfusion seems promising to improve the removal of some toxic metabolites in extracorporeal therapies. However, some very strongly protein-bound metabolites cannot be removed adequately with the adsorbers tested.

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Section: Discussionmentioning

confidence: 99%

Section: Extracorporeal Blood Purificationmentioning

confidence: 99%

In vitro Removal of Protein-Bound Retention Solutes by Extracorporeal Blood Purification Procedures

Schildboeck,

Harm,

Hartmann

2024

Blood Purif

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Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

Mehta¹,

Paul²,

Ansari³

et al. 2023

World J Crit Care Med

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BACKGROUND Despite various therapies to treat sepsis, it is one of the leading causes of mortality in the intensive care unit patients globally. Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies (ECT) which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators. AIM To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes. METHODS In this review, an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis. A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts. RESULTS Results showed that ECT techniques such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, and CytoSorb ® are emerging as adjunct therapies to improve hemodynamic stability in sepsis. CytoSorb ® has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores, lactate levels, total leucocyte count, platelet count, interleukin- IL-6, IL-10, and TNF levels. CONCLUSION Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials. In addition to patient-tailored therapies, future research developments with therapies targeting the cellular level of the immune response are expected.

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Sequential use of hemadsorption using Cytosorb® and Biosky® filter- technology in a COVID-19 patient suffering from severe ARDS

Cited by 2 publications

References 18 publications

In vitro Removal of Protein-Bound Retention Solutes by Extracorporeal Blood Purification Procedures

In vitro Removal of Protein-Bound Retention Solutes by Extracorporeal Blood Purification Procedures

Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

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