Baris ARSLAN, Çağatay KÜÇÜKBİNFÖZ, Mustafa KUTUK, Hasan Murat GUNDUZ

A single-center experience with resin adsorption hemoperfusion combined with continuous veno-venous hemofiltration for septic shock patients

Our primary goal was to investigate whether treatment of CVVH-HP in patients with septic shock caused decreased vasoconstrictor and inotropic drug requirements. As a secondary objective, to determine whether CVVH-HP had an effect on inflammatory biomarkers and mortality. 11 septic shock patients who received CVVH-HP treatment within 12 months were included in the study. The following parameters were taken from patients’ medical records; hemodynamic parameters, infection markers, inotropes and vasopressors use. Also, Intensive care mortality and duration of ICU stay were assessed. The survival rate after the 24 hours from the start of treatment was 63.6% and 28 days survival rate was 36.4%. Four of the remaining seven survivors at the 24 hours were discharged home. CVVH- HP treatment was associated with an increase of mean arterial pressure, reduction of vasoconstrictor/ionotropic requirement, reduction of C-reactive protein and procalcitonin levels. In our retrospective study, we found that patients treated with CVVH-HP treatment had approximately 40% reduction in norepinephrine and dopamine requirement in the first 24 hours and patients had higher mean arterial pressures.

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Ronco C, Brendolan A, Dan M et al. Adsorption in sepsis. Kidney Int. 2000;58:148–55.

Huang Z, Wang SR, Su W, et al. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial. 2010;14:596–602.

Liu LY, Zhu YJ, Li XL, et al. Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofi ltration for patients with multiple organ dysfunction syndrome. World J Emerg Med . 2012;33:44–8.

Cader RA, Gafor HA, Mohd R, et al. Coupled plasma filtration and adsorption (CPFA): A single center experience. Nephrourol Mon. 2013;5:891–6.

Namas RR, Zamora R, Namas RR et al. Sepsis: Something old, something new, and a systems view. J Crit Care. 2012;27:314.e1-314.e11.

Mao HJ, Yu S, Yu XB et al. Effects of coupled plasma filtration adsorption on immune function of patients with multiple organ dysfunction syndrome. Int J Artif Organs. 2009;32:31–8.

Zhou F, Peng Z, Murugan R, et al. Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit Care Med. 2013;41:2209–20.

Scielzo R, Caramazza L, Circone R, et al. Intravenous immunoglobulin in the prevention of infections in high-risk pediatric neurosurgery. Minerva Anestesiol. 1992;58:235–8.

Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6.

Dellinger RP, Levy MM, Rhodes A et al. Surviving sepsis campaign. Crit Care Med. 2013;41:580–637.

Singer M, Deutschman CS, Seymour CW et al. The Third International consensus definitions for Sepsis and septic shock (Sepsis-3). Jama. 2016;315:801–10.

Nakada T, Oda S, Ken-ichi M et al. Continuous hemodiafiltration with PMMA hemofilter in the treatment of patients with septic shock. Mol Med. 2008;14:257-63.

Hassan J, Abdul Cader R, Kong NCT, et al. Coupled plasma filtration adsorption (CPFA) plus continuous veno-venous Haemofiltration (CVVH) versus CVVH alone as an adjunctive therapy in the treatment of sepsis. EXCLI J. 2013;12:681–92.

Franchi M, Giacalone M, Traupe I et al. Coupled plasma filtration adsorption improves hemodynamics in septic shock. J Crit Care. 2016;33:100–5.

Adamik B, Zielinski S, Smiechowicz J, et al. Endotoxin elimination in patients with septic shock: an observation study. Arch Immunol Ther Exp (Warsz). 2015;63:475–83.

Shum HP, Yan WW, Chan TM. Extracorporeal blood purification for sepsis. Hong Kong Med J. 2016;22:478–85.

Stanley TH, Sperry RJ, editors. Anesthesia and the Lung. Springer Science & Business 1992.

Rhodes A, Evans LE, Alhazzani W et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock. Intensive Care Med.2016;33:304-77.