Use of CytoSorb in Traumatic Amputation of the Forearm and Severe Septic Shock

Abstract

Severe trauma associated with later disability and mortality still constitutes a major health and socioeconomic problem throughout the world. While primary morbidity and mortality are mostly related to initial injuries and early complications, secondary lethality is strongly linked to the development of systemic inflammatory response syndrome, sepsis, and ultimately multiple organ dysfunction syndrome. We herein report on a 49-year-old male patient who was admitted to the hospital after a traumatic amputation of his right forearm that was cut off while working on a landfill. After initial treatment for shock, he received immediate replantation and was transferred to the ICU. Due to the anticipated risk of a complex infection, continuous renal replacement therapy in combination with CytoSorb was initiated. During the course of the combined treatment, a rapid improvement in hemodynamics was noticed, as well as a significant reduction of IL-6 and lactate levels. Despite a recurring septic episode and the necessity for amputation, the patient clinically stabilized and underwent complete recovery. The early treatment with a combination of CVVHDF and CytoSorb was accompanied by an attenuation of the systemic inflammatory reaction, which subsided without major or permanent organ damage, despite the impressive pathogen spectrum and the pronounced local damage.

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

“…Serum proinflammatory cytokine levels peak within 2 h of cellular injury and return to almost undetectable levels within 6 h [3]. IL-6 is released by tissue macrophages and is an early and potent inflammatory mediator [6]. IL-1β (catabolin) potentiates this early inflammatory response and amplifies the synthesis of other proinflammatory cytokines such as IL-6, IL-8, IL-12, and TNF-α [3].…”

Hemadsorption therapy in critically ill patients - double blind bet?

“…Adsorpční systém CytoSorb® (CytoSorbents, New Jersey, USA) předsta vuje vysoce kapacitní adsorpční médium schopné adsorpce molekul o hmotnosti 5-60 kDa tvořené porézními polymerovanými kuličkami s povrchem 45 000 m 2 , které přineslo řadu slibných výsledků v dílčích kazuistických sděleních [1][2][3]. Retrospektivní analýza série 26 případů časného užití adsorpčního systému zaznamenala u sledovaných pa cientů rychlou hemodynamickou stabilizaci a snížení 28denní mortality; z analýzy však byli vyloučeni pacienti s předpokládanou dobou přežití kratší než 28 dní -celkový počet vyřazených pacientů studie neuvádí [4].…”