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Extracorporeal blood purification (ECBP) has become a popular treatment option for non-steroidal anti-inflammatory drug (NSAID) toxicity in small animals. However, challenges arise when using ECBP for small dogs and cats because the priming volume required by most machine-based ECBP platforms might be excessive, leading to cardiovascular instability if a blood prime is not used. This report describes the successful use of manual carbon hemoperfusion (MCHP) to reduce plasma meloxicam levels in a cat following an inadvertent overdose and its use in a dog following suspected ibuprofen ingestion. In both animals, MCHP reduced the circuit volume needed for ECBP from 125 mL with a machine-based therapeutic plasma exchange or 104 mL with an in-series carbon hemoperfusion on an intermittent hemodialysis platform to just 40--50 mL. In the cat, MCHP reduced plasma meloxicam levels by 44%, and in both animals, the use of MCHP in these pets was well-tolerated and safe. Due to pre-existing anemia, the cat required a blood transfusion but the dog did not. MCHP is technically simple and can be performed at any hospital with access to carbon filters and blood bank resources. This technique may represent a reasonable alternative to treat NSAID toxicities in animals that are too small for conventional extracorporeal decontamination methods using either machine-based platforms without using a blood prime or in locations where these machines are unavailable. [ABSTRACT FROM AUTHOR]

Chronic kidney disease–associated pruritus (CKD-aP) is a common complication in dialysis patients which is not fully addressed by pharmacological and dialytic therapy. The objective was to review the literature on the effects of extracorporeal blood purification modalities on CKD-aP. The population comprised patients aged ≥18 years on chronic dialysis. PubMed, Embase, and Medline were systematically searched until February 2024 for clinical studies comparing the effect of different dialysis modalities on pruritus intensity. Two reviewers extracted data independently. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane tool. Any extracorporeal blood purification therapy for the treatment of CKD-aP was included. Outcome was quantitative change in pruritus intensity on a validated itching scale. This review included eight RCTs examining five different dialysis modalities, three observational studies examining three dialysis modalities, and six prospective clinical trials assessing four dialysis modalities. These treatments included peritoneal dialysis, low-flux and high-flux dialysis, hemodiafiltration, expanded hemodialysis, hemadsorption, hemodiafiltration with endogenous reinfusion and dialysis with polymethylmethacrylate membrane. Risk of bias was high in most studies. The largest body of evidence was found for the efficacy of hemadsorption. Limitations of evidence included heterogeneity in diagnostic tools and treatment, risk of selection bias, small sample sizes and short follow-up durations that made it challenging to perform a robust systematic review and meta-analysis. Despite the high prevalence of pruritus among dialysis patients, current evidence for efficacy of standard dialytic treatment is weak. The only technique that appears to be effective is hemoadsorption alone or coupled with hemodialysis. More high-quality studies are needed to confirm the long-term benefits. [ABSTRACT FROM AUTHOR]

Abstract Background IL-6 is a pleiotropic cytokine modulating inflammation and metabolic pathways. Its proinflammatory effect plays a significant role in organ failure pathogenesis, commonly elevated in systemic inflammatory conditions. Extracorporeal blood purification devices, such as the Advanced Organ Support (ADVOS) multi hemodialysis system, might offer potential in mitigating IL-6's detrimental effects, yet its efficacy remains unreported. Methods We conducted a proof-of-concept in vitro study to assess the ADVOS multi system's efficacy in eliminating IL-6. Varying concentrations of IL-6 were introduced into a swine blood model and treated with ADVOS multi for up to 12 h, employing different blood and concentrate flow rates. IL-6 reduction rate, clearance, and dynamics in blood and dialysate were analyzed. Results IL-6 clearance rates of 0.70 L/h and 0.42 L/h were observed in 4 and 12-h experiments, respectively. No significant differences were noted across different initial concentrations. Reduction rates ranged between 40 and 46% within the first 4 h, increasing up to 72% over 12 h, with minimal impact from flow rate variations. Our findings suggest that an IL-6-albumin interaction and convective filtration are implicated in in vitro IL-6 elimination with ADVOS multi. Conclusions This study demonstrates for the first time an efficient and continuous in vitro removal of IL-6 by ADVOS multi at low blood flow rates. Initial concentration-dependent removal transitions to more consistent elimination over time. Further clinical investigations are imperative for comprehensive data acquisition.

Background: IL-6 is a pleiotropic cytokine modulating inflammation and metabolic pathways. Its proinflammatory effect plays a significant role in organ failure pathogenesis, commonly elevated in systemic inflammatory conditions. Extracorporeal blood purification devices, such as the Advanced Organ Support (ADVOS) multi hemodialysis system, might offer potential in mitigating IL-6's detrimental effects, yet its efficacy remains unreported. Methods: We conducted a proof-of-concept in vitro study to assess the ADVOS multi system's efficacy in eliminating IL-6. Varying concentrations of IL-6 were introduced into a swine blood model and treated with ADVOS multi for up to 12 h, employing different blood and concentrate flow rates. IL-6 reduction rate, clearance, and dynamics in blood and dialysate were analyzed. Results: IL-6 clearance rates of 0.70 L/h and 0.42 L/h were observed in 4 and 12-h experiments, respectively. No significant differences were noted across different initial concentrations. Reduction rates ranged between 40 and 46% within the first 4 h, increasing up to 72% over 12 h, with minimal impact from flow rate variations. Our findings suggest that an IL-6-albumin interaction and convective filtration are implicated in in vitro IL-6 elimination with ADVOS multi. Conclusions: This study demonstrates for the first time an efficient and continuous in vitro removal of IL-6 by ADVOS multi at low blood flow rates. Initial concentration-dependent removal transitions to more consistent elimination over time. Further clinical investigations are imperative for comprehensive data acquisition. [ABSTRACT FROM AUTHOR]

Extracorporeal blood purification (ECBP) has become a popular treatment option for non-steroidal anti-inflammatory drug (NSAID) toxicity in small animals. However, challenges arise when using ECBP for small dogs and cats because the priming volume required by most machine-based ECBP platforms might be excessive, leading to cardiovascular instability if a blood prime is not used. This report describes the successful use of manual carbon hemoperfusion (MCHP) to reduce plasma meloxicam levels in a cat following an inadvertent overdose and its use in a dog following suspected ibuprofen ingestion. In both animals, MCHP reduced the circuit volume needed for ECBP from 125 mL with a machine-based therapeutic plasma exchange or 104 mL with an in-series carbon hemoperfusion on an intermittent hemodialysis platform to just 40–50 mL. In the cat, MCHP reduced plasma meloxicam levels by 44%, and in both animals, the use of MCHP in these pets was well-tolerated and safe. Due to pre-existing anemia, the cat required a blood transfusion but the dog did not. MCHP is technically simple and can be performed at any hospital with access to carbon filters and blood bank resources. This technique may represent a reasonable alternative to treat NSAID toxicities in animals that are too small for conventional extracorporeal decontamination methods using either machine-based platforms without using a blood prime or in locations where these machines are unavailable.

Background: Left ventricular assist device (LVAD) candidates are at increased risk of immune dysregulation and infectious complications. To attenuate the elevated proinflammatory cytokine levels and associated adverse clinical outcomes, it has been postulated that extracorporeal blood purification could improve the overall survival rate and morbidity of patients undergoing LVAD implantation. Methods: We retrospectively reviewed prospectively collected data of 15 patients who underwent LVAD implantation at our center between January 2021 and March 2022. Of these, 15 (100%) who received HeartMate 3™ (St. Jude Medical, Abbott, MN, USA) device were eligible. Intraoperatively, patients were single randomized 1:1:1 to three groups: group 1, patients who received Cytosorb therapy (n = 5; installed in the CPB circuit); group 2, patients who received Jafron HA330 (n = 5; installed in the CPB circuit); and control group 3, patients who did not receive filter (n = 5; usual care, neither Cytosorb nor Jafron during CPB). Baseline patient characteristics and intraoperative data were compared between the groups. Blood sample analyses were performed to assess the levels of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) in both preoperative and postoperative data. Results: Baseline patient characteristics were similar in all three groups. We found that IL1α; IL 6; IL8; Lactatedehydrogenase, PCT, pro-BNP, CRP; Leukocyte, and TNFα levels significantly increased with LVAD implantation and that neither Cytosorb nor Jafron influenced this response. In-hospital mortality and overall survival during follow-up were similar among the groups. Conclusion: Our preliminary results showed that hemoadsorption therapy using Cytosorb or Jafron hemoadsorption (HA) 330 may not be clinically beneficial for patients with advanced heart failure undergoing LVAD implantation. Large prospective studies are needed to evaluate the potential role of HA therapy in improving outcomes in patients undergoing LVAD implantation.

The development of new extracorporeal blood purification (EBP) techniques has led to increased application in clinical practice but also inconsistencies in nomenclature and misunderstanding. In November 2022, an international consensus conference was held to establish consensus on the terminology of EBP therapies. It was agreed to define EBP therapies as techniques that use an extracorporeal circuit to remove and/or modulate circulating substances to achieve physiological homeostasis, including support of the function of specific organs and/or detoxification. Specific acute EBP techniques include renal replacement therapy, isolated ultrafiltration, hemoadsorption, and plasma therapies, all of which can be applied in isolation and combination. This paper summarizes the proposed nomenclature of EBP therapies and serves as a framework for clinical practice and future research. [ABSTRACT FROM AUTHOR]

Introduction: When the kidneys or liver fail, toxic metabolites accumulate in the patient's blood, causing cardiovascular and neurotoxic complications and increased mortality. Conventional membrane-based extracorporeal blood purification procedures cannot remove these toxins efficiently. The aim of this in vitro study was to determine whether commercial hemoperfusion adsorbers are suitable for removing protein-bound retention solutes from human plasma and whole blood as well as to compare the removal to conventional hemodialysis. Methods: For in vitro testing of the removal of protein-bound substances, whole blood and plasma were spiked with uremic retention solutes (homocysteine, hippuric acid, indoxyl sulfate, 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid) and the toxins of liver failure (bilirubin, cholic acid, tryptophan, phenol). Subsequently, the protein binding of each retention solute was determined. The adsorption characteristics of the hemoperfusion adsorbers, Jafron HA and Biosky MG, both approved for the adsorption of protein-bound uremic retention solutes and Cytosorb, an adsorber recommended for adsorption of cytokines, were tested by incubating them in spiked whole blood or plasma for 1 h. Subsequently, the adsorption characteristics of the adsorbers were tested in a dynamic system. For this purpose, a 6-h in vitro hemoperfusion treatment was compared with an equally long in vitro hemodialysis treatment. Results: Hippuric acid, homocysteine, indoxyl sulfate, and tryptophan were most effectively removed by hemodialysis. Bilirubin and cholic acid were removed best by hemoperfusion with Cytosorb. A treatment with Jafron HA and Biosky MG showed similar results for the adsorption of the tested retention solutes and were best for removing phenol. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid could not be removed with any treatment method. Discussion/Conclusion: A combination of hemodialysis with hemoperfusion seems promising to improve the removal of some toxic metabolites in extracorporeal therapies. However, some very strongly protein-bound metabolites cannot be removed adequately with the adsorbers tested. [ABSTRACT FROM AUTHOR]

PurposeIn septic shock patients, pathogens and excessive endotoxins continuously overstimulate the host’s immune system with a cytokine storm that can lead to multi-organ failure and even mortality. Various types of extracorporeal blood purification treatments have recently been introduced to remove excessive endotoxins and cytokines. Herein, we compared the clinical efficacy of two blood purification methods, PMX-HP and AN69-oXiris, and discussed their detailed indications according to disease severity.Materials and methodsFrom December 2016 to April 2023, patients who underwent emergent surgery due to septic shock secondary to peritonitis and subsequently received blood purification treatment with AN69-oXiris or PMX-HP were enrolled. Propensity score (PS)-matching was conducted to adjust for baseline characteristics between the two groups, and the changes in clinical parameters and outcomes were compared. Clinical outcomes were assessed in subgroups of patients who underwent PMX-HP treatment divided according to SOFA scores into low (0–7), intermediate (8–13), and high (> 13) disease severity groups.ResultsForty patients received blood purification therapy with either PMX-HP or AN69-oXiris during the study period. After 1:2 PS matching, six patients in the AN69-oXiris group and 12 patients in the PMX-HP group were finally analyzed. Vasoactive-inotropic scores (VISs) decreased in both groups after 48 h of treatment compared to the baseline values, but the change in VISs was more pronounced in the PMX-HP group {−57.6 [interquartile range (IQR) = −166.4 – (−10)] vs. -22.9 [IQR = −64–0], respectively, p = 0.041}. Decreases in cardiovascular SOFA scores were significantly pronounced in the PMX-HP group [−1.5 (IQR = −4 – 0) vs. 0 (IQR = −1 – 1), respectively, p = 0.035]. The 7-day mortality rate was significantly lower than the predicted mortality rate in a subgroup analysis of patients treated with PMX-HP in both the low disease severity group and the intermediate disease severity group.ConclusionPMX-HP and AN69-oXiris could be therapeutic options for refractory septic shock patients with intra-abdominal origins, especially after the surgical elimination of the infectious sources. A tailored modality choice that takes into account patient characteristics, such as disease severity and cost burden, could optimize the efficacy of this strategy.

In 2022, we celebrated the 15th anniversary of the University of Alabama at Birmingham (UAB) Continuous Renal Replacement Therapy (CRRT) Academy, a 2-day conference attended yearly by an international audience of over 100 nephrology, critical care, and multidisciplinary trainees and practitioners. This year, we introduce the proceedings of the UAB CRRT Academy, a yearly review of select emerging topics in the field of critical care nephrology that feature prominently in the conference. First, we review the rapidly evolving field of non-invasive hemodynamic monitoring and its potential to guide fluid removal by renal replacement therapy (RRT). We begin by summarizing the accumulating data associating fluid overload with harm in critical illness and the potential for harm from end-organ hypoperfusion caused by excessive fluid removal with RRT, underscoring the importance of accurate, dynamic assessment of volume status. We describe four applications of point-of-care ultrasound used to identify patients in need of urgent fluid removal or likely to tolerate fluid removal: lung ultrasound, inferior vena cava ultrasound, venous excess ultrasonography, and Doppler of the left ventricular outflow track to estimate stroke volume. We briefly introduce other minimally invasive hemodynamic monitoring technologies before concluding that additional prospective data are urgently needed to adapt these technologies to the specific task of fluid removal by RRT and to learn how best to integrate them into practical fluid-management strategies. Second, we focus on the growth of novel extracorporeal blood purification devices, starting with brief reviews of the inflammatory underpinnings of multiorgan dysfunction and the specific applications of pathogen, endotoxin, and/or cytokine removal and immunomodulation. Finally, we review a series of specific adsorptive technologies, several of which have seen substantial clinical use during the COVID-19 pandemic, describing their mechanisms of target removal, the limited existing data supporting their efficacy, ongoing and future studies, and the need for additional prospective trials. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the impact of sequential extracorporeal treatments with oXiris® or CytoSorb® plus Seraph-100® on the clinical and laboratory parameters of critically ill COVID-19 patients with bacterial superinfection. Methods: Patients admitted to the intensive care unit with COVID-19, bacterial superinfection, and undergoing blood purification (BP) were enrolled in this prospective, single-center, observational study. "standard BP" with oXiris® or CytoSorb® were used in 35 COVID-19 patients with bacterial infection. Seraph-100® was added in 33 patients when available serially in the same oXiris® circuit or as sequential treatment with CytoSorb® as a sequential BP. Results: A significant reduction in SOFA score 3 days after treatment was observed in patients undergoing sequential BP (11.3 vs. 8.17, p < 0.01) compared to those undergoing "standard BP" (11.0 vs. 10.3, p > 0.05). The difference between the observed and expected mortality rate based on APACHE IV was greater in the sequential BP group (42.4% vs. 81.7%, p < 0.001) than the "standard BP" (74.2% vs. 81.7%, p > 0.05). Patients treated with sequential BP had a longer survival than those treated with "standard BP" (22.4 vs. 18.7 months; p < 0.001). Conclusions: The sequential approach may enhance the positive effect of BP on organ dysfunction among critically ill patients with COVID-19 and bacterial superinfection. [ABSTRACT FROM AUTHOR]

The objective was to analyze the clinical and economic feasibility of using selective methods of lipopolysaccharide (LPS) sorption for sepsis treatment.Materials and methods. A clinical and economic model was used to assess the feasibility of using some technologies of selective lipopolysaccharide sorption. The model was developed in accordance with the current industry standard «Clinical and Economic Research» used in Russia. The target population was patients of 18 years old and older with sepsis. The methodology involved the evaluation of available randomized clinical trials, as well as studies involving data from network meta-analyses and systematic reviews of the use of the studied technologies. The calculation of direct medical and indirect non-medical costs was made with an analysis of the impact on the budget during the first year and on the time horizon for five years.Results. The value of direct and indirect costs was determined when using sorption devices based on Efferon LPS, Toraymyxin, Alteco LPS Adsorber, Toxipak columns. It was shown that among the therapeutic alternatives, the use of the Efferon LPS column had the least burden on the budget.Conclusion. The use of selective lipopolysaccharide sorption technologies in the intensive care program for sepsis patients, although accompanied by an increase in direct and indirect financial costs, leads to budget savings in the medium term. Improving the mechanism for compensating the costs of using this technology is a promising way to improve the outcomes of sepsis treatment.

Abstract Both high mobility group box-1 (HMGB1) and histones are major damage-associated molecular patterns (DAPMs) that mediate lethal systemic inflammation, activation of the complement and coagulation system, endothelial injury and multiple organ dysfunction syndrome in critical illnesses. Although accumulating evidence collectively shows that targeting HMGB1 or histones by their specific antibodies or inhibitors could significantly mitigate aberrant immune responses in multiple critically ill animal models, routine clinical use of such agents is still not recommended by any guideline. In contrast, extracorporeal blood purification, which has been widely used to replace dysfunctional organs and remove exogenous or endogenous toxins in intensive care units, may also exert an immunomodulatory effect by eliminating inflammatory mediators such as cytokines, endotoxin, HMGB1 and histones in patients with critical illnesses. In this review, we summarize the multiple immunopathological roles of HMGB1 and histones in mediating inflammation, immune thrombosis and organ dysfunction and discuss the rationale for the removal of these DAMPs using various hemofilters. The latest preclinical and clinical evidence for the use of extracorporeal blood purification to improve the clinical outcome of critically ill patients by targeting circulating HMGB1 and histones is also gathered.

Abstract Background Hemoadsorption (HA) might mitigate the systemic inflammatory response associated with post-cardiac arrest syndrome (PCAS) and improve outcomes. Here, we investigated the feasibility, safety and efficacy of HA with CytoSorb® in cardiac arrest (CA) survivors at risk of PCAS. Methods In this pilot randomized controlled trial, we included patients admitted to our intensive care unit following CA and likely to develop PCAS: required norepinephrine (> 0.2 µg/kg/min), and/or had serum lactate > 6 mmol/l and/or a time-to-return of spontaneous circulation (ROSC) > 25 min. Those requiring ECMO or renal replacement therapy were excluded. Eligible patients were randomly allocated to either receive standard of care (SOC) or SOC plus HA. Hemoadsorption was performed as stand-alone therapy for 24 h, using CytoSorb® and regional heparin–protamine anticoagulation. We collected feasibility, safety and clinical data as well as serial plasma cytokines levels within 72 h of randomization. Results We enrolled 21 patients, of whom 16 (76%) had out-of-hospital CA. Median (IQR) time-to-ROSC was 30 (20, 45) minutes. Ten were assigned to the HA group and 11 to the SOC group. Hemoadsorption was initiated in all patients allocated to the HA group within 18 (11, 23) h of ICU admission and conducted for a median duration of 21 (14, 24) h. The intervention was well tolerated except for a trend for a higher rate of aPTT elevation (5 (50%) vs 2 (18%) p = 0.18) and mild (100–150 G/L) thrombocytopenia at day 1 (5 (50%) vs 2 (18%) p = 0.18). Interleukin (IL)-6 plasma levels at randomization were low ( 1000 pg/mL) in 6 (29%). The median relative reduction in IL-6 at 48 h was 75% (60, 94) in the HA group versus 5% (− 47, 70) in the SOC group (p = 0.06). Conclusions In CA survivors at risk of PCAS, HA was feasible, safe and was associated with a nonsignificant reduction in cytokine plasma levels. Future trials are needed to further define the role of HA after CA. Those studies should include cytokine assessment to enrich the study population. Trial registration: NCT03523039, registered 14 May 2018.

Both high mobility group box-1 (HMGB1) and histones are major damage-associated molecular patterns (DAPMs) that mediate lethal systemic inflammation, activation of the complement and coagulation system, endothelial injury and multiple organ dysfunction syndrome in critical illnesses. Although accumulating evidence collectively shows that targeting HMGB1 or histones by their specific antibodies or inhibitors could significantly mitigate aberrant immune responses in multiple critically ill animal models, routine clinical use of such agents is still not recommended by any guideline. In contrast, extracorporeal blood purification, which has been widely used to replace dysfunctional organs and remove exogenous or endogenous toxins in intensive care units, may also exert an immunomodulatory effect by eliminating inflammatory mediators such as cytokines, endotoxin, HMGB1 and histones in patients with critical illnesses. In this review, we summarize the multiple immunopathological roles of HMGB1 and histones in mediating inflammation, immune thrombosis and organ dysfunction and discuss the rationale for the removal of these DAMPs using various hemofilters. The latest preclinical and clinical evidence for the use of extracorporeal blood purification to improve the clinical outcome of critically ill patients by targeting circulating HMGB1 and histones is also gathered. [ABSTRACT FROM AUTHOR]

Background: Hemoadsorption (HA) might mitigate the systemic inflammatory response associated with post-cardiac arrest syndrome (PCAS) and improve outcomes. Here, we investigated the feasibility, safety and efficacy of HA with CytoSorb® in cardiac arrest (CA) survivors at risk of PCAS. Methods: In this pilot randomized controlled trial, we included patients admitted to our intensive care unit following CA and likely to develop PCAS: required norepinephrine (> 0.2 µg/kg/min), and/or had serum lactate > 6 mmol/l and/or a time-to-return of spontaneous circulation (ROSC) > 25 min. Those requiring ECMO or renal replacement therapy were excluded. Eligible patients were randomly allocated to either receive standard of care (SOC) or SOC plus HA. Hemoadsorption was performed as stand-alone therapy for 24 h, using CytoSorb® and regional heparin–protamine anticoagulation. We collected feasibility, safety and clinical data as well as serial plasma cytokines levels within 72 h of randomization. Results: We enrolled 21 patients, of whom 16 (76%) had out-of-hospital CA. Median (IQR) time-to-ROSC was 30 (20, 45) minutes. Ten were assigned to the HA group and 11 to the SOC group. Hemoadsorption was initiated in all patients allocated to the HA group within 18 (11, 23) h of ICU admission and conducted for a median duration of 21 (14, 24) h. The intervention was well tolerated except for a trend for a higher rate of aPTT elevation (5 (50%) vs 2 (18%) p = 0.18) and mild (100–150 G/L) thrombocytopenia at day 1 (5 (50%) vs 2 (18%) p = 0.18). Interleukin (IL)-6 plasma levels at randomization were low (< 100 pg/mL) in 10 (48%) patients and elevated (> 1000 pg/mL) in 6 (29%). The median relative reduction in IL-6 at 48 h was 75% (60, 94) in the HA group versus 5% (− 47, 70) in the SOC group (p = 0.06). Conclusions: In CA survivors at risk of PCAS, HA was feasible, safe and was associated with a nonsignificant reduction in cytokine plasma levels. Future trials are needed to further define the role of HA after CA. Those studies should include cytokine assessment to enrich the study population. Trial registration: NCT03523039, registered 14 May 2018. [ABSTRACT FROM AUTHOR]

Patients with serious thermal burn injuries require immediate and specialized care in order to minimize morbidity and mortality. Optimal fluid resuscitation, nutritional support, pulmonary care, burn wound care, and infection control practices represent key aspects of patient care in burn centers. When severely burned, the patient usually presents a systemic inflammatory response syndrome, soon balanced by a counter anti-inflammatory response syndrome. These may lead to immune dysregulation/exhaustion favoring infectious complications that dramatically impair the prognosis of burn patients. This narrative review provides an overview of the main concepts, current understanding, and potential applications of extracorporeal blood purification techniques for burn patient management. Current understanding of burn patients' immune responses is reported. Hypotheses and data on the potential value of immunoregulation are reviewed. Finally, how extracorporeal blood purification may be of interest in this specific population is discussed. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal blood purification (EBP) treatments may be used in patients with sepsis and related conditions to mitigate toxic systemic inflammation, prevent or reverse vital organ injury, and improve outcome. These treatments lack demonstrable efficacy, but are generally considered safe. However, since late 2020, four clinical studies of EBP treatment using adsorbent devices in inflammatory disease reported significantly increased patient mortality associated with the adsorbent treatments. Criticisms of study design and execution were published, but revealed no decisive flaws. None of these critiques considered possible toxic effects of the adsorbent treatments per se. Perspective and conclusion: In adsorbent EBP treatment of systemic inflammatory disease the adsorbent media are deployed in patient blood or plasma flow for the purpose of broad spectrum, non-specific adsorptive removal of inflammatory mediators. Adsorption and sequestration of inflammatory mediators by adsorbent media is intended to reduce mediator concentrations in circulating blood and neutralize their activity. However, in the past two decades developments in both biomedical engineering and the science of cytokine molecular dynamics suggest that immobilization of inflammatory proteins on solid scaffolds or molecular carriers may stabilize protein structure and preserve or amplify protein function. It is unknown if these mechanisms are operative in EBP adsorbent treatments. If these mechanisms are operative, then the adsorbent medium could become reactive, promoting inflammatory activity which could result in negative outcomes. Considering the recent reports of harm with adsorbent treatments in diverse inflammatory conditions, caution urges investigation of these potentially harmful mechanisms in these devices. Candidate mechanisms for possible inquiry are discussed. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal blood purification with CytoSorb has been increasingly used as an adjunctive therapy in several hyperinflammatory critical care conditions, as well as to remove elevated levels of myoglobin or bilirubin in patients with rhabdomyolysis or liver failure. Despite the increasing worldwide use of hemoadsorption, data from large international multicenter studies are still lacking., Objective: The COSMOS (CytoSorb Treatment Of Critically Ill Patients) registry is a company-sponsored registry by CytoSorbents Corporation and CytoSorbents Medical Inc. and will provide a data repository and reporting infrastructure for the surveillance of CytoSorb use in real-world critical care settings in an unselected, critically ill patient population. The gathered data will serve as a comprehensive resource to assess the effects of such therapy on patients' management., Methods: The international COSMOS registry is collecting prospective data for patients treated with CytoSorb during routine care in various critical care indications, based on the decision of the treating physicians. Data are collected at baseline, during CytoSorb therapy, 24 hours thereafter, at discharge from the intensive care unit and the hospital, and on day 90. Key outcomes assessed include change in inflammatory biomarkers, vasopressor requirements, fluid balance, organ function and organ support, length of intensive care unit and hospital stay, occurrence of adverse events, and mortality., Results: The COSMOS registry started with the inclusion of the first patient on July 15, 2022, and is now actively enrolling in 4 countries (Germany, Spain, Portugal, and Italy), with plans to expand to other countries outside of Europe. An initial readout is planned for presentation at an international Critical Care conference in 2024., Conclusions: The COSMOS registry is intended to provide comprehensive real-world data on patient outcomes with CytoSorb in various critical care indications, thereby contributing to optimization of patient selection, timing of initiation, and dosing of hemoadsorption treatment., Trial Registration: ClinicalTrials.gov NCT05146336; https://clinicaltrials.gov/study/NCT05146336., International Registered Report Identifier (irrid): DERR1-10.2196/55880., (©Fabio Silvio Taccone, Frank Martin Brunkhorst, Gabriella Bottari, Jorge Hidalgo, Andreas Kribben, Jean-Louis Teboul, Dana Tomescu, Teresa Klaus, Joerg Scheier, Efthymios Deliargyris, Ricard Ferrer. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.11.2024.)

Purpose: To evaluate the efficacy of the novel oXiris® membrane in critically ill adult patients., Methods: We systematically searched MEDLINE, EMBASE, and CENTRAL from inception to 01/06/2023 for relevant randomised controlled trials (RCTs) and non-randomised studies of intervention (NRSI). The primary outcome was overall mortality. Random effect meta-analyses were conducted in RevMan 5.4.1. Study quality was evaluated using Cochrane's risk of bias tool. (PROSPERO: CRD42023389198)., Results: Ten studies (2 RCTs and 8 NRSIs) with 481 patients were included. None had low risk of bias. Treatment using oXiris® was associated with reduced overall mortality (RR 0.78, 95%CI 0.62-0.98; p = 0.03; 6 NRSI). One RCT reported 28-day mortality, finding no significant difference between groups. Besides, pooled NRSIs results showed significant reductions in SOFA scores, norepinephrine dosage, and several inflammatory biomarkers (C-reactive protein [CRP], lactate, and interleukin-6 [IL-6]) post oXiris® treatment. However, other clinical outcomes (ICU and hospital length of stay, mechanical ventilation duration) were similar between groups., Conclusion: In critically ill patients, the use of oXiris® membrane was associated with reduced overall mortality, norepinephrine dosage, CRP, IL-6, lactate levels, along with improved organ function. However, the certainty of evidence was very low, necessitating high-quality RCTs to further evaluate its efficacy in this population., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier Inc.)

The use of unopposed oral anticoagulants while undergoing cardiothoracic surgery is associated with severe bleeding and increased morbidity. The aim of this experimental study was to examine if the apixaban concentration in reconstituted blood could be reduced in an in vitro setup by the use of CytoSorb whole blood adsorber, and to study how this affected global coagulation assays. An experimental study performed in a laboratory. An in vitro setup with reconstituted whole blood. Reconstituted whole blood spiked with apixaban circulated in an in vitro circuit with the CytoSorb 300 mL device connected. Blood samples were drawn at 0, 5, 15, 30, 60, and 120 minutes of adsorption. The apixaban concentration was measured at each time point. In addition, the global coagulation assays, thromboelastometry clotting time and thrombin generation, were performed, and the results were compared with baseline values obtained before spiking blood with apixaban. After 30 minutes of adsorption, the mean apixaban concentration was reduced from 414.3 (±69.1) ng/mL to 33 (±11.4) ng/mL. Thrombin generation showed maximum effect after 60 minutes, and the thromboelastometry clotting time was close to baseline values after 120 minutes. In this in vitro study, apixaban concentrations were effectively reduced, and the clotting time and thrombin generation assays were normalized by the use of CytoSorb whole blood adsorber. [ABSTRACT FROM AUTHOR]

Abstract 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.

This study tried to investigate the impact of oXiris filter on both clinical and laboratory parameters in critically‐ill COVID‐19 intensive care unit (ICU) patients receiving extracorporeal blood purification and the clinical setting for the initiation of therapy. 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. We have found a significant decrease of SOFA score, respiratory status improved and the chest x‐ray severity score was significantly decreased after 72 h of treatment. IL‐6 significantly decreased after 72 h 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. 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. [ABSTRACT FROM AUTHOR]

Abstract Background The EMiC2 membrane is a medium cut-off haemofilter (45 kiloDalton). Little is known regarding its efficacy in eliminating medium-sized cytokines in sepsis. This study aimed to explore the effects of continuous veno-venous haemodialysis (CVVHD) using the EMiC2 filter on cytokine clearance. Methods This was a prospective observational study conducted in critically ill patients with sepsis and acute kidney injury requiring kidney replacement therapy. We measured concentrations of 12 cytokines [Interleukin (IL) IL-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, vascular endothelial growth factor, monocyte chemoattractant protein (MCP)-1, epidermal growth factor (EGF)] in plasma at baseline (T0) and pre- and post-dialyzer at 1, 6, 24, and 48 h after CVVHD initiation and in the effluent fluid at corresponding time points. Outcomes were the effluent and adsorptive clearance rates, mass balances, and changes in serial serum concentrations. Results Twelve patients were included in the final analysis. All cytokines except EGF concentrations declined over 48 h (p

Background: The urgency of the treatment of severe COVID-19 is due to high mortality rate both in general patient population (6.4%) and in patients in intensive care units (25.8%). The cytokine storm is a pathological condition leading to high mortality. There are 2 approaches to reducing inflammatory cytokines in blood: blocking their production by drugs and extracorporeal removal. However, the choice is rather challenging.Purpose: A literature analysis was carried out to study modern approaches to prescribing medications and using extracorporeal detoxification for the blockade of the cytokine storm in severe COVID-19 patients.Material and methods: A total of 47 literature sources were analyzed.Results: The obtained information on modern methods of blocking the cytokine storm in severe COVID-19 infection indicates the effectiveness of both tocilizumab and selective anticytokine hemosorption as well as plasmapheresis and methods of renal replacement therapy.Conclusion: Based on our clinical observations, it was found out that not only drug suppression of inflammatory cytokines but also methods of extracorporeal blood purification can be effective in the treatment of severe COVID-19 pneumonia

Alternating therapeutic plasma exchange with double plasma molecular adsorption system can rapidly remove bilirubin and ammonia and supplement the essential substance from the blood, which could be used as an effective treatment for fulminant hepatic failure. [ABSTRACT FROM AUTHOR]

Objective: Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model. Methods: Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine. Results: There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. Conclusion: The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters. [ABSTRACT FROM AUTHOR]

The objective: to provide pathogenetic justification for the need for extracorporeal blood purification in the new coronavirus infection.Results: the article analyzes guidelines and the first experience of using extracorporeal methods in the new coronavirus infection in different countries. It has been demonstrated that methods of extracorporeal blood purification have complex pleiotropic (multiple) effects and can quickly normalize the level of cytokines and other pathogenic factors, thereby preventing/reducing the severity of organ disorders. The article specifies the criteria for choosing an extracorporeal method, as well as indications for its early and late use.

Abstract Alternating therapeutic plasma exchange with double plasma molecular adsorption system can rapidly remove bilirubin and ammonia and supplement the essential substance from the blood, which could be used as an effective treatment for fulminant hepatic failure.

Sepsis and septic shock affect anywhere between 100 and 1000/100,000 person-years and 19 per 100,000 person-years depending on the cohort studied, with mortality rates ranging between 20% and 50%. The recently updated Sepsis 3.0 consensus definitions state that sepsis is an infection accompanied by life-threatening organ dysfunction caused by a dysregulated host response. Given the pivotal role of cytokine production in sepsis and post major surgery, it follows that removal of these substances may attenuate the response particularly in the early phase of sepsis.

We report a 42‐year‐old patient who had Hodgkin lymphoma and developed bilateral symmetrical peripheral gangrene (SPG) in the feet and hands, which occurred during septic shock after autologous hematopoietic stem‐cell transplantation. SPG is a rare but severe complication of disseminated intravascular coagulation (DIC) and is frequently associated with sepsis. The pathophysiology of SPG includes DIC‐mediated intravascular thrombosis and thrombotic occlusion of microcirculation, resulting in low blood flow. Sepsis‐induced hypotension has been suspected as one of the other causes of SPG, and it is thought to be aggravated by vasopressor treatments given for hypotension. Our patient first experienced coldness, paleness, and cyanosis in his body's acral parts, and then SPG later developed in both his feet and hands. Septic shock management was performed with cytokine hemoadsorption, broad‐spectrum antibiotics, and massive fluid replacement rapidly. The patient fully recovered without the need for amputation. Hemoadsorption is an extracorporeal cytokine‐adsorption method for removing excess cytokines. Prompt management of septic shock and early monitoring of peripheral ischemia are essential to avoid SPG. [ABSTRACT FROM AUTHOR]

Extracorporeal blood purification (EBP) therapies, using oXiris® haemofilter, are popular and used globally in intensive care units for management of patients with septic acute kidney injury (AKI). Herein, we present a case of an immunocompromised renal transplant recipient with sepsis and AKI who was treated with continuous renal replacement therapy (CRRT) using oXiris® haemofilter. A 45-year-old female who underwent cadaveric renal transplantation in 2015 was admitted due to septic shock secondary to Escherichia coli urinary tract infection (bacteraemia) and acute respiratory distress syndrome (ARDS). Her acute physiology and chronic health assessment score was 23, sepsis-related organ failure score was 11 and Glasgow coma scale was 15. She was intubated because of moderate ARDS and administered vasopressors due to hemodynamic instability. For immunosuppressive therapy, methylprednisolone (40 mg q12h) was administered. Antimicrobial therapies, including intravenous meropenem, linezolid, trimethoprim-sulfamethoxazole, voriconazole and oseltamivir, were administered. She exhibited metabolic acidosis and septic AKI and was classified as Kidney Disease Improving Global Outcomes stage 3. Therefore, CRRT with oXiris® haemofilter was administered at the 11th hour after admission. A full recovery of transplant renal function and diuresis was observed 7 days after admission. She was transferred to ward after 9 days and discharged after 2 weeks, without the requirement of RRT. EBP is proposed as an adjuvant therapy for sepsis and AKI. Solid organ transplant recipients with septic AKI may benefit from early usage of oXiris® haemofilter with CRRT as a novel approach for improving survival and clinical outcomes. [ABSTRACT FROM AUTHOR]

COVID-19 associated cytokine storm could rapidly induce ARDS, and the patients would require mechanical ventilation. However, the prognosis was not that optimistic. The outcome might be changed if the timely intervention of EBP was performed. We present a case of severe SARS-CoV-2 infection who recovered from a cytokine storm.

Abstract Background Heavy metal poisoning can cause debilitating illness if left untreated, and its management in anuric patients poses challenges. Literature with which to guide clinical practice in this area is rather scattered. Case presentation We present a case of symptomatic lead and arsenic poisoning from use of Ayurvedic medicine in a 28-year-old man with end-stage kidney disease on chronic hemodialysis. We describe his treatment course with chelating agents and extracorporeal blood purification, and review the relevant literature to provide general guidance. Conclusion Cumulative clinical experience assists in identifying preferred chelators and modalities of extracorporeal blood purification when managing such patients. However, a larger body of real-world or clinical trial evidence is necessary to inform evidence-based guidelines for the management of heavy metal poisoning in anuric patients.

Abstract Background Therapeutic plasma exchange (TPE) is used increasingly in small animals to remove circulating large molecular products such as antibodies, pathogenic proteins, and protein‐bound toxins. Specific, efficient, and safe protocols need to be developed. Hypothesis/Objectives To describe the technique of membrane‐based TPE, the resulting physiological and metabolic changes, and to define an adequate regional citrate anticoagulation protocol. Animals Thirty‐four dogs treated with TPE (2011‐2017). Methods Retrospective review of all TPE treatments performed at the Vetsuisse Faculty, University of Bern, identified through a search of the institutional database for extracorporeal treatments. Results Sixty‐four treatments were performed, resulting in 1.0 plasma volume exchange (range, 0.4‐1.1). Replacement fluids included fresh frozen plasma (12%‐100% volume), colloids (0%‐52%), human albumin (0%‐41%), and saline (0%‐70%). Anticoagulation was performed with regional citrate (n = 24), systemic heparinization (n = 2), or combined (n = 38). Main relevant laboratory changes included a 24.7% decrease in total proteins (interquartile range, 16.7‐31.4; P

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 purpose of 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.

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. [ABSTRACT FROM AUTHOR]

In December 2019, the 2019 novel coronavirus disease (COVID-19), which has been identified to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China and spread across the world. Higher plasma levels of cytokines, including interleukin (IL)-6, IL-2, IL-7, IL-10, and tumor necrosis factor-α, were found in patients with COVID-19, which implies the occurrence of a cytokine storm and its association with disease severity. Extracorporeal blood purification has been proven to effectively remove the released inflammatory cytokines. In this study, we report on a patient with COVID-19 who benefited from hemoadsorption.

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Background: The EMiC2 membrane is a medium cut-off haemofilter (45 kiloDalton). Little is known regarding its efficacy in eliminating medium-sized cytokines in sepsis. This study aimed to explore the effects of continuous veno-venous haemodialysis (CVVHD) using the EMiC2 filter on cytokine clearance.Methods: This was a prospective observational study conducted in critically ill patients with sepsis and acute kidney injury requiring kidney replacement therapy. We measured concentrations of 12 cytokines [Interleukin (IL) IL-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, vascular endothelial growth factor, monocyte chemoattractant protein (MCP)-1, epidermal growth factor (EGF)] in plasma at baseline (T0) and pre- and post-dialyzer at 1, 6, 24, and 48 h after CVVHD initiation and in the effluent fluid at corresponding time points. Outcomes were the effluent and adsorptive clearance rates, mass balances, and changes in serial serum concentrations.Results: Twelve patients were included in the final analysis. All cytokines except EGF concentrations declined over 48 h (p < 0.001). The effluent clearance rates were variable and ranged from negligible values for IL-2, IFN-γ, IL-1α, IL-1β, and EGF, to 19.0 ml/min for TNF-α. Negative or minimal adsorption was observed. The effluent and adsorptive clearance rates remained steady over time. The percentage of cytokine removal was low for most cytokines throughout the 48-h period.Conclusion: EMiC2-CVVHD achieved modest removal of most cytokines and demonstrated small to no adsorptive capacity despite a decline in plasma cytokine concentrations. This suggests that changes in plasma cytokine concentrations may not be solely influenced by extracorporeal removal.Trial Registration: NCT03231748, registered on 27th July 2017. [ABSTRACT FROM AUTHOR]

Objective: To evaluate dogs treated with hemodialysis for severe metaldehyde intoxication and to compare them with conventionally‐managed patients. Design: Retrospective study (2012–2017). Setting: University teaching hospital. Animals: Data from 18 dogs with severe metaldehyde intoxication were analyzed. Eleven dogs were treated with intermittent hemodialysis and 7 managed conventionally. Interventions: None. Measurement and main results: Metaldehyde poisoning was diagnosed based on clinical signs and toxicological analysis or presence of turquoise material in the gastrointestinal content. Clinical signs, additional treatments, dialysis prescription, duration of anesthesia and hospitalization, complications, and outcome were documented. Results were analyzed by t‐test, Mann–Whitney U‐test, and Chi‐square test. P < 0.05 was considered significant. Dialysis was performed for median (range) 180 min (150–420 min) with median of 2.28 L/kg (1.66–4.48 L/kg) blood volume processed. In the hemodialysis group, anesthesia was discontinued at a median of 3.0 hours (1.5–6.7 h) after starting dialysis. The conventional‐group received general anesthesia for a median of 17.5 hours (7.0–30.5 h). No further anticonvulsive treatment was necessary for the hemodialysis group. Time to hospital discharge was shorter in dialyzed dogs (median 18 h; 15–41 h) compared to conventionally treated dogs (median 89 h; 61–168 h; P = 0.0014). Aspiration pneumonia was reported in 5 conventionally treated dogs and none of the dialyzed dogs (P = 0.001). Five dialyzed dogs developed hematoma at the dialysis catheter site. One dog in each group was euthanized. Conclusion: Hemodialysis significantly decreases the requirement for anesthesia and length of hospitalization in dogs with metaldehyde intoxication. Aspiration pneumonia occurred less often in dialyzed patients. Prospective studies are warranted to confirm the clinical utility of hemodialysis in dogs with metaldehyde poisoning. [ABSTRACT FROM AUTHOR]

Purpose: In septic shock patients, pathogens and excessive endotoxins continuously overstimulate the host's immune system with a cytokine storm that can lead to multi-organ failure and even mortality. Various types of extracorporeal blood purification treatments have recently been introduced to remove excessive endotoxins and cytokines. Herein, we compared the clinical efficacy of two blood purification methods, PMX-HP and AN69-oXiris, and discussed their detailed indications according to disease severity., Materials and Methods: From December 2016 to April 2023, patients who underwent emergent surgery due to septic shock secondary to peritonitis and subsequently received blood purification treatment with AN69-oXiris or PMX-HP were enrolled. Propensity score (PS)-matching was conducted to adjust for baseline characteristics between the two groups, and the changes in clinical parameters and outcomes were compared. Clinical outcomes were assessed in subgroups of patients who underwent PMX-HP treatment divided according to SOFA scores into low (0-7), intermediate (8-13), and high (> 13) disease severity groups., Results: Forty patients received blood purification therapy with either PMX-HP or AN69-oXiris during the study period. After 1:2 PS matching, six patients in the AN69-oXiris group and 12 patients in the PMX-HP group were finally analyzed. Vasoactive-inotropic scores (VISs) decreased in both groups after 48 h of treatment compared to the baseline values, but the change in VISs was more pronounced in the PMX-HP group {-57.6 [interquartile range (IQR) = -166.4 - (-10)] vs. -22.9 [IQR = -64-0], respectively, p  = 0.041}. Decreases in cardiovascular SOFA scores were significantly pronounced in the PMX-HP group [-1.5 (IQR = -4 - 0) vs. 0 (IQR = -1 - 1), respectively, p  = 0.035]. The 7-day mortality rate was significantly lower than the predicted mortality rate in a subgroup analysis of patients treated with PMX-HP in both the low disease severity group and the intermediate disease severity group., Conclusion: PMX-HP and AN69-oXiris could be therapeutic options for refractory septic shock patients with intra-abdominal origins, especially after the surgical elimination of the infectious sources. A tailored modality choice that takes into account patient characteristics, such as disease severity and cost burden, could optimize the efficacy of this strategy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kim, Chung, Lee and Kim.)

Introduction: Severe COVID-19 is associated with a dysregulated immune response that usually leads to cytokine release syndrome. This study aimed to compare the use of extracorporeal blood purification therapy (Oxiris ® ) versus standard continuous renal replacement therapy (CRRT) in critically-ill patients with severe COVID-19., Methods: This was a national, multicenter, retrospective study of patients with COVID-19 admitted to the intensive care unit (ICU) between March and October 2020 who required CRRT. Patients were categorized into two groups: Oxiris ® CRRT and standard CRRT. The primary outcome was the number of patients alive and ventilator-free at 30-days post-CRRT treatment. Key secondary endpoints included change in inflammatory markers, Sequential Organ Failure Assessment (SOFA) scores, and PaO 2 /FiO 2 ratio at 24- and 72-h post Oxiris ® initiation., Results: Thirty-five patients received Oxiris ® CRRT and 23 patients received standard CRRT. The primary outcome was 31.4% in the Oxiris ® group versus 4.3% in the standard CRRT group (adjusted odds ratio 5.97, 95% confidence interval [CI], 0.64-55.6; p  = 0.117). In the Oxiris ® group, interleukin-6 (IL-6) concentrations significantly decreased at 24 and 72-h ( p  = 0.033) and PaO 2 /FiO 2 ratio significantly increased at 24 and 72 h after Oxiris ® initiation ( p  = 0.001). There was no significant change in SOFA scores at 24- and 72-h after Oxiris ® initiation., Conclusion: The number of patients alive and ventilator-free at 30-days was higher in the Oxiris ® group than that in the standard CRRT group; however, the difference did not reach statistical significance after adjusting for the baseline severity of illness. There was a significant reduction in IL-6 and significant improvement in PaO 2 /FiO 2 ratio after Oxiris ® CRRT initiation., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Therapeutic plasma exchange (TPE) is used increasingly in small animals to remove circulating large molecular products such as antibodies, pathogenic proteins, and protein‐bound toxins. Specific, efficient, and safe protocols need to be developed. Hypothesis/Objectives: To describe the technique of membrane‐based TPE, the resulting physiological and metabolic changes, and to define an adequate regional citrate anticoagulation protocol. Animals: Thirty‐four dogs treated with TPE (2011‐2017). Methods: Retrospective review of all TPE treatments performed at the Vetsuisse Faculty, University of Bern, identified through a search of the institutional database for extracorporeal treatments. Results: Sixty‐four treatments were performed, resulting in 1.0 plasma volume exchange (range, 0.4‐1.1). Replacement fluids included fresh frozen plasma (12%‐100% volume), colloids (0%‐52%), human albumin (0%‐41%), and saline (0%‐70%). Anticoagulation was performed with regional citrate (n = 24), systemic heparinization (n = 2), or combined (n = 38). Main relevant laboratory changes included a 24.7% decrease in total proteins (interquartile range, 16.7‐31.4; P < .001), 53% in fibrinogen (−30 to 63; P =.009), 36% in bilirubin (13‐43, P =.02), 9.0% in urea (0.7‐15.7; P < .001), and 4.5% in creatinine (−6.6 to 10.6; P =.006). Citrate accumulation was evidenced in all dogs, more pronounced in those with renal but not with hepatic impairment. Maximal tolerable citrate rates were estimated as 5.5 and 9.0 μmol/kg/min for treatments in dogs with and without renal impairment, respectively. Complications were observed in 22 treatments (34%) and were fatal in 2 dogs. Conclusions and Clinical Importance: Therapeutic plasma exchange causes metabolic and biochemical alterations. Understanding these effects makes possible to anticipate most complications and to improve safety of the procedure. [ABSTRACT FROM AUTHOR]

Sepsis and septic shock affect anywhere between 100 and 1000/100,000 person-years and 19 per 100,000 person-years depending on the cohort studied, with mortality rates ranging between 20% and 50%. The recently updated Sepsis 3.0 consensus definitions state that sepsis is an infection accompanied by life-threatening organ dysfunction caused by a dysregulated host response. Given the pivotal role of cytokine production in sepsis and post major surgery, it follows that removal of these substances may attenuate the response particularly in the early phase of sepsis. [ABSTRACT FROM AUTHOR]