Case of the week 1/27/2016
CytoSorb in a case of postoperative sepsis in a patient with necrotizing pancreatitis
Lutz Badura, Hospital Eilenburg
Summary:
This case study reports on a 65-year-old female patient with underlying cholelithiasis undergoing a surgical procedure for severe necrotizing pancreatitis
Case presentation
Postoperatively progressing demand for catecholamines, and signs for multiple organ failure (lung, circulatory, kidney, gut)
Sharp increase of PCT and CRP
Treatment
Three consecutive CytoSorb treatment sessions of 23 hours each over a total period of 72 hours, separated from one another by a pause interval of 1 hours
Cytosorb was used in conjunction with CRRT (machine Baxter BM11a/BM14) run in CVVHF mode
Blood flow rate: 120 ml/min
Anticoagulation: citrate
CytoSorb adsorber position: pre-hemofilter
Measurements
IL-6, PCT, CRP
Demand for catecholamines
Renal function
Results
Treatment resulted a stabilization of the hemodynamic condition with decreased need for catecholamines
Declining plasma levels of markers of infection and inflammation
Marked improvement of renal function with beginning diuresis already during the treatment
Patient Follow-Up
Despite regular lavage in the following days and an initial control of the systemic, inflammatory situation the patient suffered a relapse with multiple organ failure in the further course and died
Conclusions
In this patient, treatment with CytoSorb resulted in a significant stabilization of hemodynamics with declining needs for catecholamines and improving organ functions especially of the kidney
Handling of the absorber was easy and intuitive
