Search

BACKGROUND: The use of left ventricular assist devices (LVAD) in patients with advance heart failure is still associated with an important risk of immune dysregulation and infections. The aim of this study was to determine whether extracorporeal blood purification using the CytoSorb device benefits patients after LVAD implantation in terms of complications and overall survival.MATERIALS AND METHODS: Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation, of whom 72 underwent CytoSorb therapy and 135 did not. Overall survival, major adverse events, and laboratory parameters were compared between 112 propensity score-matched patients (CytoSorb: 72 patients; non-CytoSorb: 40 patients).RESULTS: WBC (p = .033), CRP (p = .001), and IL-6 (p < .001), significantly increased with LVAD implantation, while CytoSorb did not influence this response. In-hospital mortality and overall survival during follow-up were similar with CytoSorb. However, patients treated with CytoSorb were more likely to develop respiratory failure (54.2% vs. 30.0%, p = .024), need mechanical ventilation for longer than 6 days post-implant (50.0% vs. 27.5%, p = .035), and require tracheostomy during hospitalization (31.9% vs. 12.5%, p = .040). No other significant differences were observed with regard to major adverse events during follow-up.CONCLUSIONS: Overall, our results showed that CytoSorb might not convey a significant morbidity or mortality benefit for patients undergoing LVAD implantation.

Introduction This study tried to investigate the impact of oXiris filter on both clinical and laboratory parameters in critically ill COVID-19 ICU patients receiving extracorporeal blood purification and the clinical setting for the initiation of therapy. Methods A consecutive sample of 15 ICU patients with COVID-19 was treated with oXiris membrane for blood purification or for support of renal function due to acute kidney injury. We have included 19 non treated ICU COVID-19 patients as a control group. Two chest X-rays were analyzed for determining the chest x-ray severity score. Results We have found a significant decrease of SOFA score, respiratory status improved and the chest X-ray severity score was significantly decreased after 72h of treatment. Il-6 significantly decreased after 72h of treatment while other inflammatory markers did not. Respiratory status in the control group worsened as well as increase in SOFA score and chest X-ray severity score. Survived patients have shorter time from the onset of symptoms before starting with extracorporeal blood purification treatment and shorter time on vasoactive therapy and invasive respiratory support than deceased patients. Conclusion Critically-ill patients with COVID-19 treated with extracorporeal blood purification survived significantly longer than other ICU COVID-19 patients. Treatment with oXiris membrane provides significant reduction of Il-6, leads to improvement in respiratory status, chest X-ray severity score, and reduction of SOFA score severity. Our results can suggest that ICU COVID-19 patients in an early course of a disease could be potentially a target group for earlier initiation of extracorporeal blood purification. This article is protected by copyright. All rights reserved.

BACKGROUND Therapeutic plasma exchange (TPE) has been used increasingly to treat immunological diseases in dogs, although data concerning its efficacy are lacking. HYPOTHESIS/OBJECTIVES To describe the clinic and the outcome of dogs with immune-mediated hematological disorders (IMHD) treated with membrane filtration TPE. ANIMALS One hundred forty-six dogs diagnosed with IMHD, including 17 dogs treated with and 129 control dogs treated without TPE. METHODS Retrospective study of cases selected with a search of all medical records for dogs diagnosed with IMHD (2010-2019). Primary outcomes included the assessment of safety and efficacy of adjunctive TPE compared to medical treatment alone. RESULTS The TPE group included 7 dogs with immune-mediated hemolytic anemia (IMHA), 5 dogs with immune-mediated thrombocytopenia (IMT), and 5 dogs with combined IMHA-IMT; the control group included 63 dogs with IMHA, 47 dogs with IMT, and 19 dogs with IMHA-IMT. Dogs treated with TPE were more often refractory to initial immunosuppression (71%) than controls (43%; P = .04). Complications were observed in 15/43 TPE treatments (35%). The response rate of dogs treated with TPE was 83% in IMHA (controls, 65%; P = .5) and 80% in IMT (controls, 70%; P = .71). Overall, 12/17 dogs (71%) treated with TPE reached complete remission, 2/17 (12%) partial remission, and 3/17 (18%) died or were euthanized. Eighty-two percent of the dogs treated with TPE survived to discharge (controls, 69%; P = .4). CONCLUSIONS AND CLINICAL IMPORTANCE Despite a bias toward dogs refractory to initial immunosuppression, dogs treated with adjunctive TPE had a similar outcome as dogs treated medically.

Coupled plasma filtration and adsorption (CPFA) is an extracorporeal blood purification technique proposed for the treatment of septic-shock. By removing pro- and anti-inflammatory mediators from plasma, CPFA is supposed to have a therapeutic effect on the abnormal inflammatory response seen in this condition. Recently, blood predilution with citrate solution has been adopted to prevent clotting in the CPFA circuit-one of the main problems of the technique. Taking into account the patient's hematocrit, we worked out a formula for the volume of plasma effectively treated by CPFA after predilution. Neglecting this effect, as is commonly done, introduces significant distortions in the estimation of the volume, possibly causing under-treatment. The distortion is stronger when the hematocrit and the predilution fraction are large and weaker when both values shrink. By correctly indicating the daily dose of plasma adsorption received by patients, this formula is essential for assessing the therapeutic efficacy of CPFA and, subsequently, establishing its optimal doses.

Objective: To evaluate the effect of hemodialysis, hemoperfusion, and a combined approach on the removal of metaldehyde from canine plasma. Design: In vitro study. Setting. University veterinary teaching hospital laboratory. Animals: None. Interventions: None. Measurements and Main Results: Metaldehyde-fortified canine plasma was prepared. Hemodialysis (HD), charcoal hemoperfusion (HP), and in-series hemodialysis and charcoal hemoperfusion (HD/HP) were applied in triplicate to eliminate metaldehyde from plasma. Plasma samples were obtained before starting the procedure and subsequently after every processed total plasma volume until plasma had been processed 10 times. Plasma metaldehyde concentration was quantitatively assayed by gas chromatography-mass spectrometry. Statistical analysis was performed using one-way ANOVA, repeated measures ANOVA, and Bonferroni post hoc test, and by calculating the coefficient of variation from duplicate measurements, binomial distribution, and by Bland–Altman analysis. Statistically significant reduction in metaldehyde concentration was reached by all 3 techniques. Reduction of metaldehyde concentration of more than 95% was achieved after processing the plasma volume 4 times applying HD, 8 times applying HP, and 2 times applying HD/HP. Efficacy in reduction of metaldehyde concentration differed significantly between the 3 procedures (P < 0.001). In-series hemodialysis and charcoal hemoperfusion was more effective in metaldehyde removal than HD (P = 0.003) and HP (P < 0.001), and HD was more effective than HP (P = 0.002). Conclusions: Metaldehyde was effectively removed by all applied extracorporeal blood purification techniques in vitro. However, the combination of both techniques was more effective than HD or HP alone. Further clinical studies are warranted to confirm therapeutic benefits in patients.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of extracorporeal blood purification techniques for treating paraquat poisoning.

Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances. Examples of these substances include pathogenic autoantibodies, immune complexes, cryoglobulins, myeloma light chains, endotoxin and cholesterol containing lipoproteins. The basic premise of the treatment is that removal of these substances will allow for the reversal of the pathologic processes related to their presence. This review will cover the techniques for performing TPE, the kinetics of the removal of large molecules from the plasma and the benefits and risks of the different types of replacement fluids.

Peritoneal dialysis (PD) is a simple, safe, gentle, and efficient renal replacement therapy (RRT) method. It is able to correct acute kidney injury (AKI)-induced metabolic, electrolytic, and acid-base disorders and volume overload both in and out the intensive care unit setting. Some PD modalities, such as high-volume PD and continuous flow PD, can provide RRT doses and efficiency comparable to extracorporeal blood purification methods. PD is particularly suitable for children, patients with refractory heart failure or hemodynamically instable, conditions where systemic anticoagulation should be avoided, patients with difficulty for vascular access and hypo- and hyperthermia conditions. In the following manuscript, PD technical aspects and the possible advantages and limitations of this RRT method will be discussed, and the more recent literature on clinical experience with PD for treatment of AKI will be reviewed.

Systemic inflammatory response syndrome (SIRS) is a major cause of morbidity and mortality in critically ill patients. Extracorporeal blood purification procedures are becoming important for treating these patients. However, the cost of these procedures is high. Therefore, a prognostic marker would be helpful. To establish the reliability of the Sequential Organ Failure Assessment (SOFA) score as a prognostic indicator, we evaluated daily changes in the SOFA score of 40 SIRS patients who needed blood purification procedures such as continuous renal replacement therapy (CRRT), endotoxin adsorption, bilirubin adsorption, and/or plasma exchange. Twenty patients survived and 20 died. Although the baseline scores of the two groups (survivors and non-survivors) did not differ, both the maximum value of the SOFA score and the DeltaSOFA score (the difference between the maximum SOFA and baseline SOFA scores) were significantly higher in the non-survivor group. The mortality rate among patients with a maximum SOFA score greater than or equal to 18 or a DeltaSOFA score greater than or equal to 3 was higher than for the rest of the patients. The changes in the SOFA score correlated well with the outcomes of the SIRS patients. The maximum SOFA score and the DeltaSOFA score are therefore likely to be useful prognostic markers.

Immediately after the availability of highly permeable membranes in 1979, membrane plasma separation was introduced as a mode of extracorporeal blood purification by the nephrology group at Klinikum Grosshadern of the Ludwig Maximilians University of Munich (F.R.G.). The new therapy was applied primarily in the management of immunologically mediated renal and extrarenal disorders as well as in paraproteinemias. We also have witnessed a widespread application of this extracorporeal treatment as a last resort in otherwise refractory clinical conditions. Over the years, the group at Grosshadern has contributed to the development, as well as to the laboratory and clinical testing, of new plasma separation membranes, simplified plasmapheresis formats (e.g., spontaneous membrane plasma separation), and several plasma fractionation procedures (e.g., cascade filtration, adsorption). Whenever indicated and possible, plasma fractionation procedures, rather than unselective plasma exchange, are performed in an appropriate clinical situation.