BACKGROUND Septic shock leads to multiple organ failure,and bacterial endotoxins and endogenous cytokines play essential roles in the pathogenesis.The oXiris■hemofilter can efficiently adsorb endotoxins and cytokines...BACKGROUND Septic shock leads to multiple organ failure,and bacterial endotoxins and endogenous cytokines play essential roles in the pathogenesis.The oXiris■hemofilter can efficiently adsorb endotoxins and cytokines.CASE SUMMARY We admitted a critically ill 59 year-old male patient with gastrointestinal septic shock due to infection by a Gram-negative bacterium and septic acute kidney injury(AKI).Prior to intensive care unit admission,the patient reported intermittent diarrhea and decreased urine output.His blood pressure was 70/40 mmHg,necessitating fluid resuscitation and large doses of noradrenaline.Based on the results of a blood culture and the presence of hypotension,oliguria,and hypoxemia,we diagnosed septic shock,AKI,and multiple organ dysfunction.We administered continuous renal replacement therapy(CRRT)with an oXiris■hemofilter for 72 h with intermittent continuous veno-venous hemodiafiltration(CVVHDF),and changed the filter every 12 h.After his hemodynamic parameters were stable,we used a traditional filter(AN69 hemofilter)with intermittent CVVHDF.The 72 h CRRT with the oXiris■hemofilter led to stabilization of his vital signs,marked reductions in disease severity scores,and decreased levels of procalcitonin,endotoxin,and inflammatory factors.After 8 d of CRRT,his kidney function had completely recovered.CONCLUSION We conclude that the oXiris■hemofilter combined with appropriate antibacterial therapy was an effective treatment for this patient with gastrointestinal septic shock.展开更多
BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful be...BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients.Shortening the resuscitation time through continuous renal replacement therapy(CRRT)with oXiris^(■)would be an attractive strategy in managing such patients.AIM To explore the effects of CRRT and oXiris^(■)in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022.Patients were divided into two groups based on the hemofilter used for CRRT(oXiris^(■)group,n=26;M150 group,n=19).We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups.The heart rate,norepinephrine dose,Sequential Organ Failure Assessment(SOFA)score,and blood lactic acid levels at different time points in the two groups were also compared.Blood levels of inflammatory mediators in the 26 patients in the oXiris^(■)group were measured to further infer the possible mechanism.RESULTS The average total fluid balance after 7 d of CRRT in the oXiris^(■)group was significantly lower than that of patients in the M150 hemofilter group.The SOFA scores of patients after CRRT with oXiris^(■)therapy were significantly lower than those before treatment on day 1(d1),d3 and d7 after CRRT;these parameters were also significantly lower than those of the control group on d7.The lac level after oXiris^(■)therapy was significantly lower than that before treatment on d3 and d7 after CRRT.There were no significant differences in the above parameters between the two groups at the other time points.In the oXiris^(■)group,procalcitonin levels decreased on d7,whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.CONCLUSION CRRT with oXiris^(■)hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.展开更多
文摘BACKGROUND Septic shock leads to multiple organ failure,and bacterial endotoxins and endogenous cytokines play essential roles in the pathogenesis.The oXiris■hemofilter can efficiently adsorb endotoxins and cytokines.CASE SUMMARY We admitted a critically ill 59 year-old male patient with gastrointestinal septic shock due to infection by a Gram-negative bacterium and septic acute kidney injury(AKI).Prior to intensive care unit admission,the patient reported intermittent diarrhea and decreased urine output.His blood pressure was 70/40 mmHg,necessitating fluid resuscitation and large doses of noradrenaline.Based on the results of a blood culture and the presence of hypotension,oliguria,and hypoxemia,we diagnosed septic shock,AKI,and multiple organ dysfunction.We administered continuous renal replacement therapy(CRRT)with an oXiris■hemofilter for 72 h with intermittent continuous veno-venous hemodiafiltration(CVVHDF),and changed the filter every 12 h.After his hemodynamic parameters were stable,we used a traditional filter(AN69 hemofilter)with intermittent CVVHDF.The 72 h CRRT with the oXiris■hemofilter led to stabilization of his vital signs,marked reductions in disease severity scores,and decreased levels of procalcitonin,endotoxin,and inflammatory factors.After 8 d of CRRT,his kidney function had completely recovered.CONCLUSION We conclude that the oXiris■hemofilter combined with appropriate antibacterial therapy was an effective treatment for this patient with gastrointestinal septic shock.
基金Hebei Health Science and Education Project,No.20200852.
文摘BACKGROUND The mortality rate from septic shock in patients with hematological malignancies(HMs)remains significantly higher than that in patients without HMs.A longer resuscitation time would definitely be harmful because of the irreversibly immunocompromised status of the patients.Shortening the resuscitation time through continuous renal replacement therapy(CRRT)with oXiris^(■)would be an attractive strategy in managing such patients.AIM To explore the effects of CRRT and oXiris^(■)in shortening the resuscitation time and modifying the host response by reducing inflammation mediator levels.METHODS Forty-five patients with HM were diagnosed with septic shock and underwent CRRT between 2018 and 2022.Patients were divided into two groups based on the hemofilter used for CRRT(oXiris^(■)group,n=26;M150 group,n=19).We compared the number of days of negative and total fluid balance after 7 d of CRRT between the groups.The heart rate,norepinephrine dose,Sequential Organ Failure Assessment(SOFA)score,and blood lactic acid levels at different time points in the two groups were also compared.Blood levels of inflammatory mediators in the 26 patients in the oXiris^(■)group were measured to further infer the possible mechanism.RESULTS The average total fluid balance after 7 d of CRRT in the oXiris^(■)group was significantly lower than that of patients in the M150 hemofilter group.The SOFA scores of patients after CRRT with oXiris^(■)therapy were significantly lower than those before treatment on day 1(d1),d3 and d7 after CRRT;these parameters were also significantly lower than those of the control group on d7.The lac level after oXiris^(■)therapy was significantly lower than that before treatment on d3 and d7 after CRRT.There were no significant differences in the above parameters between the two groups at the other time points.In the oXiris^(■)group,procalcitonin levels decreased on d7,whereas interleukin-6 and tumor necrosis factor levels decreased significantly on d3 and d7 after treatment.CONCLUSION CRRT with oXiris^(■)hemofilter may improve hemodynamics by reducing inflammatory mediators and playing a role in shortening the resuscitation period and decreasing total fluid balance in the resuscitation phases.
文摘目的探讨oXiris-内毒素吸附技术治疗终末期肾病(end-stage renal disease,ESRD)合并脓毒症的疗效。方法回顾性收集2020年1月1日—2023年7月30日于河南科技大学第一附属医院住院治疗的ESRD合并脓毒症患者41例,其中oXiris组22例,连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)联合血液灌流(hemoperfusion,HP)组19例。比较2组患者住院死亡率、ICU住院时长、机械通气时长、连续性肾脏替代治疗时长、机械通气患者数、使用滤器数以及在血液净化治疗开始时及治疗后急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHE-Ⅱ)、去甲肾上腺素(norepinephrine,NE)用量以及实验室检查结果。结果oXiris组患者机械通气时长少于CVVH+HP组(Z=-3.749,P=0.001)。治疗后oXiris组APACHE-Ⅱ评分(t=-4.481,P=0.001)、NE用量(t=-2.036,P=0.049)、C反应蛋白(Z=-2.850,P=0.004)、白细胞介素-6(Z=-2.512,P=0.012)水平较CVVH+HP组降低。结论oXiris-内毒素吸附技术能有效降低ESRD合并脓毒症患者炎症介质,且效果优于CVVH+HP,具有良好的临床应用价值。
