scholarly journals Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

2020 ◽  
pp. 1-11 ◽  
Author(s):  
Claudio Ronco ◽  
Sean M. Bagshaw ◽  
Rinaldo Bellomo ◽  
William R. Clark ◽  
Faeq Husain-Syed ◽  
...  
Keyword(s):  
Critically Ill ◽  
Blood Purification ◽  
Critically Ill Patient ◽  
Organ Support ◽  
Expert Review ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification

Evaluation of plasma levels of meropenem in septic patients during extracorporeal blood purification

2021 ◽  
Vol 20 (4) ◽  
pp. 81-94
Author(s):  
Artem V. Marukhov ◽  
Elena V. Murzina ◽  
Mikhail V. Zakharov ◽  
Genrikh A. Sofronov ◽  
Lyudmila V. Buryakova ◽  
...  
Keyword(s):  
Septic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Selective Adsorption ◽  
Plasma Concentrations ◽  
Blood Purification ◽  
Continuous Hemodiafiltration ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Extracorporeal Support

The relevance. Meropenem is a broad-spectrum carbapenem antibiotic widely used to treat patients with sepsis / septic shock. Critically ill patients are usually supported with one of the forms extracorporeal blood purification. However, data on the effect of various extracorporeal support techniques on the pharmacokinetics and pharmacodynamics of meropenem are insufficient or contradictory. Aim: To evaluate the effectiveness of meropenem dosage regimens in the treatment of septic patients during extracorporeal blood purification. Materials and methods. Plasma concentrations of meropenem were monitored in three critically ill patients with sepsis or septic shock. Patients were treated using various extracorporeal support techniques. Meropenem was used as empirical antibacterial mono- or complex therapy (1 g every 8 or 12 hours). Meropenem concentrations in plasma were determined by validated assay methods on Acquity ultraefficient liquid chromatography (UPLC) H-Class system. Results. It is shown that the meropenem plasma concentration in critically ill patients changes significantly. It was found that the standard meropenem dosing regimens in patients with sepsis / septic shock during continuous hemodiafiltration do not ensure the achievement of the PK/PD target of 100% TMIC for sensitive strains (MIC2 mg/L) and for intermediate resistance pathogens (2MIC8 mg/L). Continuous hemofiltration and selective adsorption of lipopolysaccharide have a less pronounced effect on the clearance of meropenem. Conclusion. To increase the effectiveness of antibacterial therapy, it is necessary to conduct research aimed at developing protocols for dosing antibacterial drugs for the treatment of sepsis during extracorporeal blood purification.

scholarly journals Kinetics of Plasma Cytokines During and After Two Different Modalities of Extracorporeal Blood Purification in Critically Ill COVID-19 Patients

2020 ◽  
Author(s):  
Daniela Ponce ◽  
Welder Zamoner ◽  
Luis Eduardo Magalhães ◽  
Paula Gabriela Souza de Oliveira ◽  
Patricia Polla ◽  
...  
Keyword(s):  
Critically Ill ◽  
Removal Rate ◽  
Kidney Injury ◽  
Blood Purification ◽  
Prognostic Scores ◽  
Removal Rates ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Intermittent Haemodialysis ◽  
Plasma Cytokines

Abstract Cytokine storm syndrome (CSS) has been documented in coronavirus disease 2019 (COVID-19) since the first reports of this disease. In the absence of vaccines or direct therapy for COVID-19, extracorporeal blood treatment (EBT) could represent an option for the removal of cytokines and may be beneficial to improve the clinical outcome of critically ill patients. Intermittent haemodialysis (IHD), using high flux (HF) or high cut-off membranes, and continuous renal replacement therapy (CRRT) could be used for blood purification in COVID-19 patients with CSS. To the best of our knowledge, cytokine kinetics during and after different types of EBT on COVID-19 patients have never been studied. In this study, we describe cytokine variation and removal during and after IHD and CRRT in COVID-19 patients with acute kidney injury (AKI). Methods: Patients with COVID-19-related AKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria and admitted at Intensive Care Unit (ICU) were studied. Blood samples were collected at the start and end of both IHD using HF membranes (10 patients) and continuous venovenous haemodiafiltration (CVVHDF: 10 patients) in two sessions for measuring 13 different plasma interleukins and calculating the cytokine removal rate. Results: We evaluated cytokine removal in patients with COVID-19-related AKI undergoing either prolonged IHD (10 patients) or CRRT (CVVHDF: 10 patients). There was no difference between the IHD and CVVHDF groups regarding mechanical ventilation, vasoactive drug use, age or prognostic scores. Patients treated by CRRT presented higher levels of IL-2 and IL-8 than patients treated by prolonged IHD at the start of dialysis. Cytokine removal ranged from 9–78%. Patients treated by CRRT presented higher cytokine removal rates than those treated by prolonged IHD for IL-2, IL-6 IL-8, IP-10 and TNF. The removal rates of IL-4, IL-10, IL-1β, IL-17A, IFN, MCP-1 and free active TGF-B1 were similar in the two groups. After one session of CVVHDF (24 h) the IL-2 and IL-1β levels did not vary significantly, whereas IL-4, IL-6, IL-8, IL-10, IL-17A, TNF, IFN, IP-10, MCP-1, IL-12p70 and free active TGF-B1 decreased by 33.8–76%, and this decrease was maintained over the next 24 h. In the prolonged IHD groups, IL-2, IL-6, TNF, IP-10 and IL-1β levels did not decrease significantly whereas IL-4, IL-8, IL-10, IL-17A, IFN, MCP-1, IL-12p70 and free active TGF-B1 decreased by 21.8–72%. However, all cytokine levels returned to their initial values after 24 h, despite their removal. Conclusions: Cytokine removal is lower using prolonged IHD with HF membranes than by using CVVHDF, and IHD allows a transient and selective decrease in cytokines that can be correlated with mortality during CSS-related COVID-19.

scholarly journals IMMUNOMODULATION, IMMUNOSTIMULATION AND EXTRACORPOREAL BLOOD PURIFICATION IN SEPSIS: POTENTIALLY BENEFICIAL TECHNIQUES IN CARDIAC SURGERY

2019 ◽  
Vol 16 (2) ◽  
pp. 96-106
Author(s):  
P. Gianluca ◽  
Á Nagy
Keyword(s):  
Immune Response ◽  
Cardiac Surgery ◽  
Clinical Signs ◽  
Blood Purification ◽  
Source Control ◽  
Molecular Diagnostic ◽  
Diagnostic Tools ◽  
Organ Support ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification

Sepsis is a potentially life-threatening state caused by an infection and an inadequate, dysregulated host immune response. Focusing on cardiac surgery, the prevalence of sepsis is low, after procedures situated between 0.39% and 2.5%. Nevertheless, the current life-expectancy of septic patients are poor, mortality varying from 65% to 79%.Pathophysiology and immunopathology of sepsis is still unclear. Actually we consider sepsis as a dynamic process with two different sides. Both immune hyperactivity and immune suppression are presented during the progression. Although immunomodulation is not a fresh idea in the treatment of sepsis. Currently the diagnosis of sepsis is based on clinical signs. The biomarkers and molecular diagnostic tools are insufficient.The actual concept of immunopathophysiology in sepsis is based on the idea of a dynamic parallel immune response, both pro- and antiinflammatory processes are presented from the beginning. Equilibrium may be the key in the immune response of sepsis. Immune system tries to maintain the homeostatic environment during sepsis via pro- and antiinflammatory processes. In case of an unbalanced, dysregulated and radical (in both directions) response mortality become frightfully high. Infectional source control, adequate antibiotic therapy and organ support are the three corner stones in the treatment of sepsis since the definition of sepsis born.In our review we would like to add a detailed overview on two promising modalities of immunomodulation: (1) extracorporeal blood purification; (2) immunostimulation.The purposeof present article is to give an up-to-date, comprehensive review on the utilization of extracorporeal blood purification techniques and immunostimulation in septic patient after cardiac surgery. 

scholarly journals Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: COMMENTARY

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005242021
Author(s):  
Marlies Ostermann ◽  
Jay L. Koyner
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Early Access ◽  
Extracorporeal Blood Purification ◽  
Multi Organ Failure

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the CON: 10.34067/KID.0007382020

scholarly journals Application of combined hemadsorption with eculizumab as rescue treatment of a pediatric patient with multiple organ failure related to severe hemolytic uremic syndrome

2021 ◽  
Vol 6 (9) ◽  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Critically Ill ◽  
Pediatric Patient ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Blood Purification ◽  
Therapy Regimen ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification ◽  
Uremic Syndrome

Many different extracorporeal blood purification techniques have been proposed in critically ill adult patients with sepsis and sepsis-like syndromes. In this context, hemoperfusion devices such as CytoSorb have been recently approved for extracorporeal cytokine removal. In the neonatal and pediatric setting however, the application of this method brings with it various challenges including profound technical difficulties with data for its application in critically ill pediatric patients remaining sparse. We present a case of a 2-year-old female patient affected by severe Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome (STECHUS) admitted to our Intensive Care Unit (ICU) with anuria, hemodynamic instability and severe neurological deterioration. By using a combined “rescue” therapy regimen with hemodiafiltration, hemadsorption (CytoSorb), plasmapheresis (PEX) and Eculizumab, the patient could be successfully stabilized, accompanied by a control of the hyperinflammatory response and an improvement in the neurological condition, finally leading to recovery. In pediatric patient extracorporeal blood purification techniques might potentially represent a promising adjuvant therapeutic option for the complications related to hemolytic uremic syndrome and hyperinflammation, but further studies are needed.

scholarly journals Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: CON

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0007382020
Author(s):  
Kianoush B. Kashani ◽  
Lui G. Forni
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Early Access ◽  
Extracorporeal Blood Purification ◽  
Multi Organ Failure

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the PRO: 10.34067/KID.0006632020 and the COMMENTARY 10.34067/KID.0005242021

scholarly journals Early initiation of Extracorporeal Blood Purification using the AN69ST (oXiris®) hemofilter as a treatment modality for COVID - 19 patients: a single-centre case series

2020 ◽  
Author(s):  
Petar Ugurov ◽  
Dijana Popevski ◽  
Tanja Gramosli ◽  
Dashurie Neziri ◽  
Dragica Vuckova ◽  
...  
Keyword(s):  
Real Time ◽  
Disease Severity ◽  
White Blood Cells ◽  
Case Series ◽  
Blood Purification ◽  
Early Initiation ◽  
Respiratory Support ◽  
Organ Support ◽  
Extracorporeal Blood ◽  
Extracorporeal Blood Purification

Abstract Introduction: Our understanding of the COVID-19 disease has been steadily evolving since the original outbreak in December 2019. Advanced disease is characterised by a hyperinflammatory state, systemic coagulopathies and multiorgan involvement, in particular respiratory distress. We here describe our initial experience with treating of COVID-19 patients based on early initiation of extracorporeal blood purification, systemic heparinisation and respiratory support.Methods: 15 patients were included; 2 were females. We monitored real-time several biochemical, immunological and coagulation biomarkers associated with disease severity following admission to our dedicated COVID-19 intensive care unit. To guide personalised treatment, we monitored among others levels of IL-6, IL-8, TNF-α, C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte ratios, Thrombocyte counts, D-Dimers, Fibrinogen, and Activation Clotting time (ACT).Treatment consisted of individualised respiratory support supplemented with 1 - 4 cycles of 24-hour Extracorporeal Organ Support (ECOS) and Blood Purification using the AN69ST (oXiris®) hemofilter. We administered heparin (300 U/kg) to counter suspected hypercoagulability (= elevated Fibrinogen or D-dimers) states to maintain ACT ≥ 180 seconds.Results: N = 10 presented with severe to critical disease (= dyspnoea, hypoxia, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). A single case was admitted with a critical condition (= respiratory failure). One patient died after 5 days of hospitalisation after developing Acute Respiratory Syndrome. 8 Patients have been discharged - average ICU length-of-stay was 9.9 ± 2.4 days. Clinical improvement was associated with normalisation (increase) of thrombocytes, white blood cells, stable levels of IL-6 (< 50 ng/mL) and a decrease of CRP and Fibrinogen. Conclusion: Means to monitor COVID-19 disease severity during hospitalisation are crucial to control disease progression and prevent hyperinflammation and irreversible multiorgan failure. We present here a real-time monitoring system accounting for biochemical, immunological, coagulation parameters and radiological imaging. The combination of systemic heparin anticoagulation regimens and blood purification may prevent hyperinflammation, thromboembolism during hospitalisation and thus support clinical recovery.

scholarly journals Extracorporeal blood purification is appropriate in critically ill patients with COVID-19 and multi-organ failure: PRO

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006632020
Author(s):  
Kevin K. Chung ◽  
Stephen W. Olson
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Purification ◽  
Extracorporeal Blood ◽  
Early Access ◽  
Extracorporeal Blood Purification ◽  
Multi Organ Failure

This is an Early Access article. Please select the PDF button, above, to view it. Be sure to also read the CON: 10.34067/KID.0007382020 and the COMMENTARY 10.34067/KID.0005242021

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