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2.
Lancet Respir Med ; 10(3): 307-312, 2022 03.
Article in English | MEDLINE | ID: covidwho-1751527

ABSTRACT

Extracorporeal haemoadsorption is increasingly being used for the removal of endotoxin or inflammatory cytokines in patients with septic shock or other severe inflammatory states. A reduction in excessively high levels of inflammatory mediators-and mitigation of the devastating clinical impact of severe inflammation-might be a sound rationale for extracorporeal haemoadsorption in critical care, but the evidence for beneficial effects is uncertain. Few randomised controlled trials have been undertaken, and they have not provided reliable evidence for routine use in clinical practice. No study has shown a survival benefit, and only a few studies have shown a significant effect on patients' blood cytokine concentrations. Nonetheless, some clinicians have encouraged the use of haemoadsorption devices, largely on the basis of incomplete data or contentious interpretations of the available data. Further research is required, particularly well designed, prospective clinical trials assessing relevant patient-centred outcomes, including mortality, before widespread adoption of this technology can be recommended.


Subject(s)
Shock, Septic , Critical Care , Cytokines , Humans , Inflammation Mediators , Prospective Studies , Shock, Septic/therapy
3.
Int J Mol Sci ; 22(23)2021 Nov 26.
Article in English | MEDLINE | ID: covidwho-1551605

ABSTRACT

The "normal" immune response to an insult triggers a highly regulated response determined by the interaction of various immunocompetent cells with pro- and anti-inflammatory cytokines. Under pathologic conditions, the massive elevation of cytokine levels ("cytokine storm") could not be controlled until the recent development of hemoadsorption devices that are able to extract a variety of different DAMPs, PAMPs, and metabolic products from the blood. CytoSorb® has been approved for adjunctive sepsis therapy since 2011. This review aims to summarize theoretical knowledge, in vitro results, and clinical findings to provide the clinician with pragmatic guidance for daily practice. English-language and peer-reviewed literature identified by a selective literature search in PubMed and published between January 2016 and May 2021 was included. Hemoadsorption can be used successfully as adjunct to a complex therapeutic regimen for various conditions. To the contrary, this nonspecific intervention may potentially worsen patient outcomes in complex immunological processes. CytoSorb® therapy appears to be safe and useful in various diseases (e.g., rhabdomyolysis, liver failure, or intoxications) as well as in septic shock or cytokine release syndrome, although a conclusive assessment of treatment benefit is not possible and no survival benefit has yet been demonstrated in randomized controlled trials.


Subject(s)
Cytokine Release Syndrome/therapy , Cytokines , Shock, Septic/therapy , Animals , Anti-Bacterial Agents , COVID-19 , Cytokine Release Syndrome/immunology , Cytokines/blood , Databases, Factual , Humans , Hyperbilirubinemia , Rhabdomyolysis , Sepsis/blood , Shock, Septic/immunology
5.
Crit Care Med ; 49(11): 1974-1982, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1475880
7.
Semin Respir Crit Care Med ; 42(5): 639-640, 2021 10.
Article in English | MEDLINE | ID: covidwho-1447393
8.
Curr Opin Crit Care ; 27(6): 582-586, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1440674

ABSTRACT

PURPOSE OF REVIEW: Sepsis and septic shock are life-threatening diseases with high mortality. Although efforts have made to improve the survivals, the outcomes are still frustrating. Blood purification was thought to be a promising adjunctive therapy to regulate the excessive cytokine storm or to reduce the endotoxin activity caused by sepsis. Critically ill COVID-19 characterized with the similar disease to sepsis may also benefit from blood purification. RECENT FINDINGS: The recent studies mainly focused on hemadsorption materials. The results of the clinical trials showed a tendency in decrease of cytokine levels and endotoxin activity and improvement in haemodynamics. However, the results were controversial. More evidence about blood purification in sepsis and COVID-19 are needed from currently ongoing trials and future well designed trials. SUMMARY: The blood purification therapy demonstrated the tendency in decrease of cytokines and endotoxin activity in different degree according to the current studies. However, the effect on mortality and haemodynamics is still in controversy. Further well designed, large sample sized studies should focus on the timing of initiating blood purification, the appropriate indications and the optimal type of blood purification membrane or cartridge to provide more evidence for clinical practice.


Subject(s)
COVID-19 , Sepsis , Shock, Septic , Critical Illness , Humans , SARS-CoV-2 , Sepsis/therapy , Shock, Septic/therapy
9.
Int J Mol Sci ; 22(4)2021 Feb 23.
Article in English | MEDLINE | ID: covidwho-1389391

ABSTRACT

Endotoxin removal therapy with polymyxin B immobilized fiber column (PMX) has been clinically applied for sepsis and septic shock patients since 1994. The effectiveness and usefulness of this therapy have been demonstrated for more than a quarter of a century. However, a documented survival benefit has not yet been demonstrable in a large, multicenter, randomized and controlled trial. Following the findings derived from a large sepsis clinical trial with PMX in North America, a new trial is ongoing to determine if PMX has a long-term survival benefit when administered to septic patients. Another approach to support a survival benefit from intervention with PMX is to utilize a detailed analysis available from a large clinical data base. The endotoxin adsorption capacity of PMX columns in vitro and the effectiveness of PMX columns can be further demonstrable in animal models. The capability of PMX and details of its mechanism of action to intervene in the sepsis cascade and impede organ dysfunction in septic patients is not fully understood. The surface antigen expression in monocytes and neutrophils are improved after PMX therapy. Immunomodulatory effects as a result of endotoxin removal and/or other mechanisms of action have been suggested. These effects and other potential immune effects may explain some of the improved effects upon organ dysfunction of sepsis and septic shock patients. Endotoxemia may be involved in the pathophysiology of other diseases than sepsis. A rapid diagnostic method to detect and target endotoxemia could allow us to practice precision medicine and expand the clinical indications of endotoxin removal therapy.


Subject(s)
Cotton Fiber , Endotoxins/blood , Endotoxins/isolation & purification , Hemoperfusion/methods , Immobilization/methods , Polymyxin B/chemistry , Sepsis/therapy , Shock, Septic/therapy , Adsorption , Animals , COVID-19/therapy , Endotoxemia/blood , Endotoxemia/therapy , Humans , Idiopathic Pulmonary Fibrosis/drug therapy , Idiopathic Pulmonary Fibrosis/therapy , Immobilization/instrumentation , Sepsis/blood , Shock, Septic/blood
10.
Crit Care Nurs Clin North Am ; 33(3): 263-274, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1300065

ABSTRACT

Sepsis is recognized as a major health care problem worldwide. In the United States, mortality from severe sepsis and septic shock remains a serious health problem; yet, the early recognition of sepsis by nurses reduces can reduce mortality, morbidity, and long-term consequences of sepsis for patients. Improving the knowledge of nurses to first recognize the early signs of sepsis and then how to apply the most up-to-date evidence-based treatments can improve outcomes. Enhanced monitoring includes the use of computerized early warning systems to alert nurses of worrisome clinical patterns and promote the early recognition of sepsis.


Subject(s)
Nursing Care , Sepsis , Shock, Septic , Humans , Resuscitation , Sepsis/diagnosis , Sepsis/therapy , Shock, Septic/diagnosis , Shock, Septic/therapy , United States
11.
Int J Artif Organs ; 44(12): 1034-1038, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1231212

ABSTRACT

Septic shock is a clinical condition with high mortality (40%-70%) and morbidity. During septic shock, there is a significant release of cytokines and other inflammatory mediators that can cause damage to different organs, known as a "cytokine storm." The cytokine storm can cause hypotension, tissue damage, metabolic acidosis, and renal failure. This clinical picture also seems to be confirmed in the context of Covid-19 patients. Hemoadsorption with CytoSorb represents an adjunctive therapy to attenuate the systemic inflammatory process and helps restore a balanced immune response. We present the clinical case of a 75-year-old man, admitted to our hospital with respiratory failure due to Sars-CoV-2 infection and secondary septic shock due to a sacral decubitus. On admission the patient presented with a clinical picture of mixed acidosis with high levels of lactate and inflammatory indexes. Simultaneously along with antibiotic therapy, we started hemoadsorption treatment with CytoSorb in combination with continuous venous-venous hemodiafiltration. At the end of the treatment the patient had recovered his vital functions and the infection was successfully treated. Use of the CytoSorb device in a Covid-19 positive patient was safe and well-tolerated. Early treatment with CytoSorb decreased interleukin 6 plasma levels and inflammatory indexes, resulting in earlier stabilization of homeostasis. This case report suggests that the use of CytoSorb could be a possible adjuvant therapy in patients with septic shock even when affected by Covid-19.


Subject(s)
COVID-19 , Shock, Septic , Aged , Cytokines , Humans , Inflammation Mediators , Male , SARS-CoV-2 , Shock, Septic/therapy
12.
Pneumologie ; 75(7): 526-530, 2021 Jul.
Article in German | MEDLINE | ID: covidwho-1192607

ABSTRACT

We present the case of a slightly obese 39-year-old patient with a severe course of COVID-19 pneumonia. The patient was referred from a hospital to regular care with suspected COVID-19 pneumonia. The initial clinical symptoms consisted of dysuria and fever. A bilateral infiltrate was seen in the chest x-ray. In the CT thorax, advanced COVID-19 typical changes were found on both sides. The COVID-19 infection was confirmed by a positive SARS-CoV-2 PCR from the nasopharynx smear. In the case of progressive ARDS with respiratory exhaustion, the patient was intubated and invasively ventilated. When a bacterial superinfection was suspected, we initiated empirical antibiotic therapy. In addition, a therapy with dexamethasone was applied. Therapy with ASA and weight-adapted semi-therapeutic low molecular weight heparin was also carried out. During the intensive care treatment the patient developed a fulminant septic shock with consecutive severe thrombocytopenia. A dilated tracheotomy was performed. The weaning progress was hampered by recurrent septic attacks. Necrosis in the area of ​​the right foot was identified as the cause of the septic relapses. As there was no alternative focus, surgical rehabilitation with partial amputation was carried out. The patient then remained infection-free and could be weaned from the respirator.


Subject(s)
COVID-19 , Shock, Septic , Adult , Amputation , Critical Care , Female , Humans , SARS-CoV-2 , Shock, Septic/diagnosis , Shock, Septic/therapy
15.
Arch Argent Pediatr ; 118(6): e514-e526, 2020 12.
Article in English, Spanish | MEDLINE | ID: covidwho-940639

ABSTRACT

Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.


El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de procesos.


Subject(s)
COVID-19/therapy , Practice Guidelines as Topic , Systemic Inflammatory Response Syndrome/therapy , Adolescent , COVID-19/physiopathology , Child , Humans , Referral and Consultation , Shock, Septic/physiopathology , Shock, Septic/therapy , Systemic Inflammatory Response Syndrome/physiopathology
17.
Postgrad Med J ; 97(1147): 312-320, 2021 May.
Article in English | MEDLINE | ID: covidwho-796616

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome (SARS) coronavirus-2 is a novel coronavirus belonging to the family Coronaviridae and is now known to be responsible for the outbreak of a series of recent acute atypical respiratory infections originating in Wuhan, China. The disease caused by this virus, termed coronavirus disease 19 or simply COVID-19, has rapidly spread throughout the world at an alarming pace and has been declared a pandemic by the WHO on March 11, 2020. In this review, an update on the pathophysiology, clinical presentation and the most recent management strategies for COVID-19 has been described. MATERIALS AND METHODS: A search was conducted for literature and various articles/case reports from 1997 to 2020 in PUBMED/MEDLINE for the keywords coronavirus, SARS, Middle East respiratory syndrome and mRNA virus. RESULTS AND CONCLUSIONS: COVID-19 has now spread globally with increasing morbidity and mortality among all populations. In the absence of a proper and effective antibody test, the diagnosis is presently based on a reverse-transcription PCR of nasopharyngeal and oropharyngeal swab samples. The clinical spectrum of the disease presents in the form of a mild, moderate or severe illness. Most patients are either asymptomatic carriers who despite being without symptoms have the potential to be infectious to others coming in close contact, or have a mild influenza-like illness which cannot be differentiated from a simple upper respiratory tract infection. Moderate and severe cases require hospitalisation as well as intensive therapy which includes non-invasive as well as invasive ventilation, along with antipyretics, antivirals, antibiotics and steroids. Complicated cases may require treatment by immunomodulatory drugs and plasma exchange therapy. The search for an effective vaccine for COVID-19 is presently in full swing, with pharmaceutical corporations having started human trials in many countries.


Subject(s)
COVID-19/diagnosis , COVID-19/therapy , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/physiopathology , COVID-19/virology , COVID-19 Testing , Glucocorticoids/therapeutic use , Humans , Plasma Exchange , Real-Time Polymerase Chain Reaction , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , SARS-CoV-2/physiology , Severe Acute Respiratory Syndrome/virology , Shock, Septic/therapy , Virus Attachment , Virus Internalization
18.
Pediatr Crit Care Med ; 21(11): e1031-e1037, 2020 11.
Article in English | MEDLINE | ID: covidwho-744635

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction. The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children provide an appropriate framework for the early recognition and initial resuscitation of children with sepsis or septic shock caused by all pathogens, including severe acute respiratory syndrome coronavirus 2. However, the potential benefits of select adjunctive therapies may differ from non-coronavirus disease 2019 sepsis.


Subject(s)
Coronavirus Infections/complications , Pediatrics/standards , Pneumonia, Viral/complications , Practice Guidelines as Topic , Sepsis/therapy , Algorithms , Attitude to Health , Betacoronavirus , COVID-19 , Child , Critical Care/standards , Humans , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Pandemics , Resuscitation/standards , SARS-CoV-2 , Sepsis/etiology , Shock, Septic/etiology , Shock, Septic/therapy , Vasoconstrictor Agents/therapeutic use
20.
Stem Cells Transl Med ; 9(12): 1488-1494, 2020 12.
Article in English | MEDLINE | ID: covidwho-718380

ABSTRACT

Sepsis is defined as life-threatening organ dysfunction caused by a deregulated immune host response to infection. The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted this multifactorial and complex syndrome. The absence of specific treatment neither against SARS-CoV-2 nor against acute respiratory distress syndrome (ARDS), the most serious stage of this infection, has emphasized the need to find alternative treatments. Several therapeutics are currently being tested, including mesenchymal stromal cells. These cells, already used in preclinical models of ARDS, sepsis, and septic shock and also in a few clinical trials, appear well-tolerated and promising, but many questions remain unanswered.


Subject(s)
COVID-19/therapy , Mesenchymal Stem Cell Transplantation , Sepsis/therapy , Shock, Septic/therapy , Animals , COVID-19/pathology , COVID-19/virology , Clinical Trials as Topic , Humans , Mesenchymal Stem Cells/cytology , Mesenchymal Stem Cells/metabolism , Respiratory Distress Syndrome/pathology , Respiratory Distress Syndrome/therapy , SARS-CoV-2/isolation & purification , Sepsis/pathology , Shock, Septic/pathology , Transplantation, Homologous
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