Thursday, December 18, 2014 11:06:30 PM
Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care.
On day 13—after the haemodynamic situation had already stabilised—we used a haemofiltration cartridge (Haemopurifier; Aethlon, San Diego, CA, USA) for 6·5 h upstream to the regular system. This cartridge is designed to bind viral glycoproteins by lectin affinity. This one-time use was well tolerated. PCR measurements taken directly before and after the use showed virus loads of 2·29?×?105 copies per mL and 7·66?×?104 copies per mL, respectively. This difference of less than a factor of 3 is within the technical variability range of the RNA PCR assay for Ebola virus and cannot be judged as a notable decrease.
What is interesting is the fact that cytokines may have been the cause of the vascular leakage, had a cytosorb filter been in place (note Fresnius below) could the patient have recovered sooner?
We initiated a continuous haemodiafiltration (Fresenius CiCa Multifiltrate; Fresenius, Bad Homburg, Germany). The calcium-citrate approach chosen bore less of a risk for haemorrhage. This therapy was given continuously up to day 27. Urine production restarted on day 22. Because phosphate was still elevated, the patient was continued with intermittent haemodialysis every 48 h until day 37.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62384-9/fulltext
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