1. No category

CytoSorb treatment - Case reports
Prof. Zsolt Molnár
[email protected]
Department of Anaesthesia and Intensive Care
University of Szeged
Hungary
Background – the results of the EProK-study
The 3 fundamental questions to answer
1. Is there infection – should I start empirical ABs?
2. Is it effective?
3. When should I stop?
The EProK-study
Trásy D et al.,(1st revision under submission)
The EProK-study
Trásy D et al.,(1st revision under submission)
Patients with
suspected infection= 209
Proven infection = 169
Effective AB = 127 (77%)
Ineffective AB = 38 (23%)
No infection = 44
Major changes […] are taking place
within the first 16-24 hours
Attenuating the cytokine storm early (<24 h)?
Recruitment started
(n=5)
Inclusion criteria
• Suspected sepsis of medical etiology
• IPPV
• PCT >3 ng/ml
Treatment group: standard care + CytoSorb 24 h
• Norepinephrine ≥ 10 µg/min
• PiCCOgroup:
confirmedstandard
normovolemia
Control
care and CO
• Signs of hypoperfusion: ScvO2, lactate, dCO2,
oligo-anuria metabolic acidosis
Main outcomes
• Primary:
• Cytokine response at T0-12-24-48: ILs, TNF, PCT, CRP
• Organ dysfunction (SOFA-score)
• Secondary:
• Leukocyte heterogeneity, T-cell activation/apoptosis,
adhesion marker expression
• Microcirculatory changes (OPS), tonometry
• Tertiary:
• Outcomes (mortality, LOS)
Experience - 5 patients
• Study 5 (2 in each arm, 1 exclusion)
• Treatment 1 (major trauma with severe SIRS)
Experience - 5 patients
SOFA score
CytoSorb
Points
18
worked?
Patient 1 control
Patient 2 CytoSorb
Patient 3 control
Patient 4 CytoSorb
Patient 5 CytoSorb
16
14
12
Both
worked?
10
8
6
Early
resuscitation
4
worked
2
0
t0
CytoSorb
t 12
t 24
t 48
Experience - 5 patients
NA: 56-20 µg/min
SOFA score - predicted mortaliryCreat: 200-407 µmol/l
%
100
Patient 1 control
Patient 2 CytoSorb
Patient 3 control
Patient 4 CytoSorb
Patient 5 CytoSorb
NA: 160-20 µg/min
EVLWi: 27-12 ml/kg
P/F: 169-399 mmHg
80
60
NA: 12-0 µg/min
Bi: 25-12 µmol/l
P/F: 169-399 mmHg
40
20
0
t0
t 12
t 24
t 48
Experience - 5 patients
Procalcitonin
ng/ml
We60feel:
Patient 1 control
Patient 2 CytoSorb
Patient 3 control
Patient 4 CytoSorb
Patient 5 CytoSorb
Continuing
treatment
Safe
and
easy
50
may be beneficial?
Attenuates the cytokine storm
40
For more:
Improves organ function
CytoSorbent Symposium –
30
Thursday 12:30-13:30
20
Q: How
to get the most
out
of
your
CytoSorb?
Arc Room
- In
whom – on what indications?
10
- For how long?
0
- On what
basis
could
treatment be
individualised?
t
t
t
t
-
0
12
24
48
Free for junior doctors (<29)!
www.sepseast.eu