Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study

Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective... Sepsis is the most common cause of death in medical intensive care units (ICU). If sepsis progresses to refractory septic shock, mortality may reach 90–100% despite optimum current therapy. Extracorporeal cytokine adsorption in addition to regular therapy was studied prospectively in refractory septic shock patients on a medical ICU. Refractory shock was defined as increasing vasopressor dose required to maintain mean arterial blood pressure above 65 mmHg or increasing lactate levels despite protocol-guided shock therapy for 6 h. We analysed noradrenaline requirements after 6 and 12 h (primary endpoint), lactate clearance after 6 and 12 h, SOFA-scores in the first days and achievement of shock reversal (i.e., normalization of lactate concentrations and sustained discontinuation of vasopressors; secondary endpoints). Twenty consecutive patients with refractory septic shock were included; CytoSorb® treatment was started after 7.8 ± 3.7 h of shock therapy. Following the initiation of adsorption therapy, noradrenaline dose could be significantly reduced after 6 (−0.4 µg/kg/min; p = 0.03) and 12 h (−0.6 µg/kg/min; p = 0.001). Lactate clearance improved significantly. SOFA-scores on day 0, 1 and 2 remained unchanged. Shock reversal was achieved in 13 (65%) patients; 28-day survival was 45%. In severe septic shock unresponsive to standard treatment, haemodynamic stabilization was achieved using cytokine adsorption therapy, resulting in shock reversal in two-thirds of these patients. The study was registered in the German Register for Clinical Trials (DRKS) No. 00005149. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Artificial Organs Springer Journals

Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study

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Publisher
Springer Japan
Copyright
Copyright © 2017 by The Japanese Society for Artificial Organs
Subject
Medicine & Public Health; Cardiac Surgery; Nephrology; Biomedical Engineering
ISSN
1434-7229
eISSN
1619-0904
D.O.I.
10.1007/s10047-017-0967-4
Publisher site
See Article on Publisher Site

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