CytoSorbents Corporation (CTSO)

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Case of the week 05/2016
CytoSorb in a case of caecum perforation and fecal 4-quadrant peritonitis

Friedrich Nestler, Hospital Erlabrunn
Summary:

This case study reports on a 76-year-old male patient who underwent emergency laparotomy due to an acute abdomen after a previous total hip replacement surgery.
Case presentation

Intraoperatively confirmed colon perforation with 4 quadrant fecal peritonitis
On admission to ICU after preceeding surgery the patient was in septic shock with need for high catecholamine doses and mechanical ventilation
Due to concomitant onset of renal failure with highly elevated inflammatory and infection markers (leucocytes 18.3, PCT 14.2, IL-6 5000, CRP 459), the patient was started on renal replacement therapy in combination with CytoSorb
Treatment

Three consecutive CytoSorb treatment sessions of 24 hours each over a total period of 72 hours
Cytosorb was used in conjunction with CRRT (Baxter BM11a/BM14) in CVVHF mode
Blood flow rate: 140 ml/min
Anticoagulation: citrate
CytoSorb adsorber position: pre-hemofilter
Measurements

IL-6, PCT, CRP, leucocytes
Demand for catecholamines
Renal function (diuresis, creatinine, urea)
Results

Hemodynamic stabilization of the patient with significantly decreased needs for catecholamines
Effective reduction of IL-6 levels down to 200 pg/ml after the last treatment
Declining plasma levels of CRP and PCT during the three CytoSorb sessions
Marked improvement of renal function with onset of spontaneous diuresis and decreasing retention parameters
Patient Follow-Up

In the further course secondary wound infection with local abdominal wall infection, requiring intraabdominal lavage, debridement and ultimately secondary abdominal wall closure
Delayed weaning, critical illness polyneuropathy
Successful transfer of the patient to a neurologic rehabilitation unit in the further course
Conclusions

Treatment with CytoSorb resulted in a significant stabilization of hemodynamics with declining needs for catecholamines, an effective reduction of inflammatory markers as well as a considerable improvement of kidney function
Handling of the absorber was safe and easy after an initial training phase

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