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Karl Träger, Daniel Fritzler, Guenther Fischer, Janpeter Schröder, Christian Skrabal, Andreas Liebold, Helmut Reinelt
The use of cardiopulmonary bypass (CPB) in cardiothoracic surgery results in a well-known activation of the immunologic response. In some cases, however, this triggered immunologic response may be excessive, leading to a severe systemic inflammatory response syndrome (SIRS) and induced organ dysfunction. For example, patients frequently develop hemodynamic instability with hypotension and low systemic vascular resistance. To date, different therapeutic approaches, such as steroids, have been tried to control this maladaptive postoperative SIRS response, yet definitive proof of clinical efficacy is missing...
May 16, 2016: International Journal of Artificial Organs
Ivan Stojkovic, Mohamed Ghalwash, Xi Hang Cao, Zoran Obradovic
Sepsis is a serious, life-threatening condition that presents a growing problem in medicine, but there is still no satisfying solution for treating it. Several blood cleansing approaches recently gained attention as promising interventions that target the main site of problem development-the blood. The focus of this study is an evaluation of the theoretical effectiveness of hemoadsorption therapy and pathogen reduction therapy. This is evaluated using the mathematical model of Murine sepsis, and the results of over 2,200 configurations of single and multiple intervention therapies simulated on 5,000 virtual subjects suggest the advantage of pathogen reduction over hemoadsorption therapy...
2016: Scientific Reports
Dana R Tomescu, Simona Olimpia Dima, Daniela Ungureanu, Mihai Popescu, Dan Tulbure, Irinel Popescu
INTRODUCTION: Emergency transplantation of a donor liver that is not matched for the major blood antigens can produce marked immune-mediated cytokine release that can cause donor graft loss. Control of the inflammatory response may be a key element in treatment. METHODS: We present the case of a 46-year-old man with primary graft nonfunction after liver transplantation who underwent emergency retransplantation with an ABO-incompatible graft. A severe inflammatory response syndrome (SIRS) was noted in the perioperioperative period of retransplantation...
May 16, 2016: International Journal of Artificial Organs
Martin H Bernardi, Harald Rinoesl, Klaus Dragosits, Robin Ristl, Friedrich Hoffelner, Philipp Opfermann, Christian Lamm, Falk Preißing, Dominik Wiedemann, Michael J Hiesmayr, Andreas Spittler
BACKGROUND: Cardiopulmonary bypass (CPB) surgery initiates a systemic inflammatory response, which is associated with postoperative morbidity and mortality. Hemoadsorption (HA) of cytokines may suppress inflammatory responses and improve outcomes. We tested a new sorbent used for HA (CytoSorb™; CytoSorbents Europe GmbH, Berlin, Germany) installed in the CPB circuit on changes of pro- and anti-inflammatory cytokines levels, inflammation markers, and differences in patients' perioperative course...
2016: Critical Care: the Official Journal of the Critical Care Forum
Sven Suefke, Friedhelm Sayk, Martin Nitschke
No abstract text is available yet for this article.
March 17, 2016: Therapeutic Apheresis and Dialysis
Katharina Linden, Vittorio Scaravilli, Stefan F X Kreyer, Slava M Belenkiy, Ian J Stewart, Kevin K Chung, Leopoldo C Cancio, Andriy I Batchinsky
INTRODUCTION: Host inflammatory response to any form of tissue injury, including burn, trauma, or shock, has been well documented. After significant burns, cytokines can increase substantially within the first 24 h after injury and may contribute to subsequent organ failure. Hemoadsorption by cytokine-adsorbing columns may attenuate this maladaptive response, thereby improving outcomes. The aim of this study was to investigate the feasibility, technical safety, and efficacy of cytokine and myoglobin removal by early use of a cytokine absorbing column (CytoSorb) in a porcine model of smoke inhalation and burn injury...
November 2015: Shock
Burkhard Hinz, Oliver Jauch, Toralf Noky, Sigrun Friesecke, Peter Abel, Rolf Kaiser
INTRODUCTION: Hemoadsorption using CytoSorb has gained attention as a potential immunotherapy to control systemic inflammation and sepsis. We report on a patient with septic shock, successfully treated with CytoSorb therapy. METHODS: A 72-year-old male with periodically recurring infectious episodes was admitted with the suspicion of urosepsis. In the following hours his hemodynamic situation deteriorated markedly, exhibiting respiratory-metabolic acidosis, elevated inflammatory marker plasma levels, a severely disturbed coagulation, increased retention parameters, liver dysfunction, and confirmation of bacteria and leucocytes in urine...
August 2015: International Journal of Artificial Organs
Tohid F Didar, Mark J Cartwright, Martin Rottman, Amanda R Graveline, Nazita Gamini, Alexander L Watters, Daniel C Leslie, Tadanori Mammoto, Melissa J Rodas, Joo H Kang, Anna Waterhouse, Benjamin T Seiler, Patrick Lombardo, Elisabet I Qendro, Michael Super, Donald E Ingber
Here we describe development of an extracorporeal hemoadsorption device for sepsis therapy that employs commercially available polysulfone or polyethersulfone hollow fiber filters similar to those used clinically for hemodialysis, covalently coated with a genetically engineered form of the human opsonin Mannose Binding Lectin linked to an Fc domain (FcMBL) that can cleanse a broad range of pathogens and endotoxin from flowing blood without having to first determine their identity. When tested with human whole blood in vitro, the FcMBL hemoadsorption filter (FcMBL-HF) produced efficient (90-99%) removal of Gram negative (Escherichia coli) and positive (Staphylococcus aureus) bacteria, fungi (Candida albicans) and lipopolysaccharide (LPS)-endotoxin...
October 2015: Biomaterials
Jicheng Zhang, Zhiyong Peng, Donald Maberry, Jacob Volpe, Jeremy D Kimmel, William J Federspiel, John A Kellum
BACKGROUND/AIMS: Hemoadsorption may improve outcomes for sepsis by removing circulating cytokines. We tested a new sorbent used for hemoadsorption. METHODS: CTR sorbent beads were filled into columns of three sizes: CTR0.5 (0.5 ml), CTR1 (1.0 ml) and CTR2 (2.0 ml) and tested using IL-6 capture in vitro. Next, rats were subjected to cecal ligation and puncture and randomly assigned to hemoadsorption with CTR0.5, CTR1, CTR2 or sham treatment. Plasma biomarkers were measured...
2015: Blood Purification
Frank Bruenger, Lukasz Kizner, Jan Weile, Michael Morshuis, Jan F Gummert
PURPOSE: A new hemoadsorption device intended as adjunctive treatment for patients with elevated cytokine levels in the setting of SIRS and sepsis has shown promising results. We report on the beneficial application of the device in a patient with cardiogenic septic shock receiving combined extracorporeal life support with rECMO, LVAD, and CVVH despite his highly septic condition. METHODS: A 39-year-old patient presented with fulminant ARDS and cardiogenic septic shock...
February 2015: International Journal of Artificial Organs
Mohammad Rashid Shahidi Bonjar, Leyla Shahidi Bonjar
The hypothesis proposed here would provide near to optimum homeostasis for patients with chronic kidney disease (CKD) without the need for hemodialysis. This strategy has not been described previously in the scientific literature. It involves a targeted therapy that may prevent progression of the disease and help to improve the well-being of CKD patients. It proposes a nanotechnological device, ie, a microarray-oriented homeostasis provider (MOHP), to improve homeostasis in CKD patients. MOHP would be an auxiliary kidney aid, and would improve the filtration functions that impaired kidneys cannot perform by their own...
2015: Drug Design, Development and Therapy
Reshma Basu, Sunjay Pathak, Jyoti Goyal, Rajeev Chaudhry, Rati B Goel, Anil Barwal
CytoSorb(®) (CytoSorbents Corporation, USA) is a novel sorbent hemoadsorption device for cytokine removal. The aim of this study was to examine the clinical use of CytoSorb(®) in the management of patient with septic shock. We used this device as an adjuvant to stabilize a young patient with multi-organ failure and severe sepsis with septic shock. A 36-year-old female patient was hospitalized with the complaints of malaise, general body ache, and breathing difficulty and had a medical history of diabetes mellitus type II, hypertension, obstructive sleep apnea, hypothyroidism and morbid obesity...
December 2014: Indian Journal of Critical Care Medicine
Hoi Ping Shum, Yuk Wah Leung, Sin Man Lam, King Chung Chan, Wing Wa Yan
BACKGROUND AND AIMS: Severe sepsis and septic shock are common causes of mortality and morbidity in an intensive care unit setting. Endotoxin, derived from the outer membranes of Gram-negative bacteria, is considered a major factor in the pathogenesis of sepsis. This study investigated the effect of Alteco endotoxin hemoadsorption device on Gram-negative septic shock patients. MATERIALS AND METHODS: An open, controlled, prospective, randomized, single-center trial was conducted between February 2010 and June 2012...
December 2014: Indian Journal of Critical Care Medicine
Hubert Hetz, Reinhard Berger, Peter Recknagel, Heinz Steltzer
INTRODUCTION: Numerous animal studies and preliminary data from a clinical trial in septic patients demonstrated that a decrease in blood cytokine levels using an extracorporeal cytokine filter (CytoSorb) can effectively attenuate the inflammatory response during sepsis and possibly improve outcomes. METHODS: A 60-year-old female was admitted to hospital due to a forearm fracture. After surgical wound care by osteosynthesis the patient developed surgical wound infection which progressed to necrotizing fasciitis...
May 2014: International Journal of Artificial Organs
Craig R Vocelka, Krystal M Jones, Krasimira M Mikhova, Ryan M Ebisu, Ashley Shar, John A Kellum, Edward D Verrier, David G Rabkin
Little is known about the effect of cardiopulmonary bypass alone on cardiac function; in an attempt to illuminate this relationship and test a possible mechanism, we used Cytosorb, a device capable of removing virtually all types of circulating cytokines to test the hypothesis that hemoadsorption of cytokines during bypass attenuates bypass-induced acute organ dysfunction. Twelve Yorkshire pigs (50-65 kg) were instrumented with a left ventricular conductance catheter. Baseline mechanics and cytokine expression (tumor necrosis factor [TNF], interleukin-6 [IL-6], and interleukin-10) were measured before and hourly after 1 hour of normothermic cardiopulmonary bypass...
December 2013: Journal of Extra-corporeal Technology
R Nishiyama, M Shinoda, M Tanabe, G Oshima, K Takano, T Miyasho, Y Fuchimoto, S Yamada, T Inoue, K Shimada, K Suda, M Tanaka, T Hayashida, H Yagi, M Kitago, H Obara, O Itano, H Takeuchi, S Kawachi, I Maruyama, Y Kitagawa
BACKGROUND: High-mobility group box chromosomal protein 1 (HMGB1) has recently been identified as an important mediator of various kinds of acute and chronic inflammation. A method for efficiently removing HMGB1 from the systemic circulation could be a promising therapy for HMGB1-mediated inflammatory diseases. MATERIALS AND METHODS: In this study, we produced a new adsorbent material by chemically treating polystyrene fiber. We first determined whether the adsorbent material efficiently adsorbed HMGB1 in vitro using a bovine HMGB1 solution and a plasma sample from a swine model of acute liver failure...
2013: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
Mia Gisselbaek, Jérôme Pugin, Gordana Pavlovic
Sepsis and its complications remain the principal cause of death in intensive care units, and is associated with high costs. Protocolized care of septic shock has however lately been associated with decreased death rates, but to date there is still no specific treatment for sepsis. Pharmacologic therapies aiming at blocking the action of bacterial endotoxin or its receptor have been largely disappointing. Epuration of circulating endotoxin using hemoadsorption on polymyxin columns is a new treatment in septic shock showing encouraging preliminary results...
December 11, 2013: Revue Médicale Suisse
Zhi-Yong Peng, Jicheng Zhang, Thomas Rimmelé, Feihu Zhou, Anan Chuasuwan, A Murat Kaynar, John A Kellum
BACKGROUND: Unlike pharmacologic interventions in sepsis, extracorporeal blood purification, which is widely used in septic patients, is not typically studied in experimental rodents. Most of the previous studies have performed extracorporeal blood purification in larger animals and typically use arteriovenous (AV) vascular access. We developed a venovenous (VV) purification model in the rat as an adjunct for the treatment of sepsis. METHODS: Using adult male Sprague-Dawley rats, we cannulated the femoral artery or vein and the jugular vein with P50 tubing and created an AV or VV circuit...
December 2013: Journal of Surgical Research
Carol A Howell, Susan R Sandeman, Gary J Phillips, Sergey V Mikhalovsky, Stephen R Tennison, Anthony P Rawlinson, Oleksandr P Kozynchenko
The aim of the present study was to develop and investigate nanoporous activated carbon materials for their ability to adsorb inflammatory cytokines directly from blood, for a range of therapeutic applications, including: systemic inflammatory response syndrome (SIRS) related to sepsis, cardio-pulmonary by-pass surgery, or ischemic reperfusion injury. Building on the previously established relationship between the porous structure of beaded polymer-derived activated carbon and its capacity to adsorb inflammatory molecules, we have developed and characterized monolithic porous carbon columns produced from the same polymer precursor matrix as carbon microbeads...
October 3, 2013: International Journal of Artificial Organs
Anne Claire Lukaszewicz, Didier Payen
After numerous negative randomized trials testing drugs for severe sepsis and/or septic shock, the blood purification approach remains one possibility. Many techniques have been proposed, having in common the goal to eliminate blood and/or plasma factors, supposed to play a negative role in outcomes. Among these, high dose of hemofiltration, high volume hemofiltration, high permeability hemofiltration and specific or non-specific hemoperfusion or hemoadsorption have been proposed. Until now, a poor level of proof has been published, questioning the pertinence of such a strategy...
2013: Critical Care: the Official Journal of the Critical Care Forum
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