ABSTRACT
BACKGROUND: Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters. Despite standard therapy, the outcomes are poor. Newer adjuvant therapy, such as CytoSorb® extracorporeal haemoadsorption device, has been investigated and shown promising outcome. However, there is a lack of some guidance to make clinical decisions on the use of CytoSorb® haemoadsorption as an adjuvant therapy in septic shock in Indian Setting. Therefore, this expert consensus was formulated. AIM: To formulate/establish specific consensus statements on the use of CytoSorb® haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario. METHODS: We performed a comprehensive literature on CytoSorb® haemoadsorption in sepsis, septic shock in PubMed selecting papers published between January 2011 and March 2023 2021 in English language. The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps. Using a modified Delphi approach combining evidence appraisal and expert opinion, the following topics related to CytoSorb® in septic shock were addressed: need for adjuvant therapy, initiation timeline, need for Interleukin -6 levels, duration of therapy, change of adsorbers, safety, prerequisite condition, efficacy endpoints and management flowchart. Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. RESULTS: Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. All 11 experts in the consensus group (100%) participated in the first, second and third round of voting. After three iterative voting rounds and adapting two statements, consensus was achieved on nine statements out of nine statements. The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb® for all indications in the open-ended question (Q10) focusing on "future recommendations for CytoSorb® therapy". CONCLUSION: This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb® haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.
Subject(s)
Organ Transplantation , Tissue and Organ Procurement , Humans , Tissue Donors , Asian People , Hospitals, PrivateABSTRACT
Post-vaccination inflammatory myositis is a rare but known entity in the literature. We encountered a 46-year-old female patient, who presented with complains of fever, arthralgia, and weakness 1 week after taking the second dose of COVID-19 (Oxford-AstraZeneca) vaccine. On workup the patient had raised inflammatory markers, evidence of myositis on magnetic resonance imaging of thighs, and evidence of interstitial lung disease on high-resolution computed tomography of the chest. The patient was further found to be positive for anti-Jo-1 antibody. The initial treatment was glucocorticosteroids and methotrexate initially. The patient briefly developed pneumocystis pneumonia and recovered. The treatment was switched to mycophenolate mofetil with good response. We presented the first case of anti-Jo-1 syndrome reported following COVID-19 vaccination in the literature. Our aim is to sensitise the clinicians to such rare but occasionally life-threatening complications that may arise in the post-vaccination period.
