CytoSorbents Corporation (CTSO)

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Case of the week 03/2017

Use of CytoSorb in septic shock after colon perforation and 4-quadrant peritonitis
Dr. med. Wojciech Palinkiewicz, PD Dr. med. Thorsten Krause | Hospital Reinbek St. Adolf-Stift GmbH (Germany), Anesthesiology, Intensive Care Medicine, Pain Therapy and palliative care


This case study reports on a 60-year-old female patient, who was hospitalized for elective debulking surgery after diagnosis of ovarian carcinoma (FIGO IV).

Case presentation
Postoperative transfer to intensive care unit and 3 days later transfer to normal ward
Deterioration in her general condition with development of an acute abdomen and relaparotomy 2 days later
After relaparotomy re-admission to the intensive care unit with septic shock after colon perforation and 4-quadrant peritonitis
At the time of admission, the patient had an APACHE 2 score of 30, severe septic shock with acute renal failure
Despite antibiotic therapy (initially meropenem and then after 24h changed to piperacillin/ tazobactam according to antibiogram) as well as protocol-based volume therapy, the patient developed a highly catecholamine-dependent cardiac insufficiency with norepinephrine dosages of up to 38 µg/min
Due to anuria despite sufficiently positive volume balance, CVVHDF therapy was initiated in conjunction with Cytosorb

Treatment
Two treatments with CytoSorb for a total duration of 48 hours (24 hours each)
Cytosorb was applied in conjunction with CRRT (Prismaflex, Gambro Hospal GmbH)  run in CVVHDF mode
Blood flow: 100-150 ml/min
Anticoagulation: citrate
CytoSorb adsorber position: post-hemofilter

Measurements
Demand of catecholamines
Parameters of infection (leucocytes, CRP, PCT)
Creatinine
SAPS 2
Lactate

Results
Shock-reversal after a total of 2 treatment cycles to <25% of the initial norepinephrine dose; – further maintenance of norepinephrine infusion was necessary most probably due to the ongoing need for analogosedation.  From day 5 the patient was catecholamine-free
Significant reduction in inflammatory parameters with CytoSorb therapy
Stabilization of lactate acidosis, after 3 days normalization of the plasma lactate values
Dose adjustment of the antibiotic therapy was not necessary


Patient Follow-Up
Completion of renal replacement therapy 30 hours after cessation of CytoSorb treatment with normal renal clearance parameters
During hospitalization, the patient developed a delirious syndrome, resulting in prolonged weaning
During hospitalization the patient had to be tracheotomized
During the recovery phases, the patient showed a left-sided hemiparesis. A CCT examination revealed the suspicion of meningeal suspensions in the context of metastases with brain swelling. However, the cerebrospinal fluid showed no malignant cells.
Tracheal decannulation 28 days after the last application of Cytosorb
Transfer to normal ward 30 days after the last Cytosorb treatment with normal renal values
Discharge to geriatric rehabilitation 69 days after the last Cytosorb adsorber application

CONCLUSIONS
Clear stabilization and consolidation of hemodynamics and inflammatory parameters under CytoSorb therapy within 48 hours
The application of CytoSorb therapy was simple, safe and the installation of the adsorbers was possible without problems

http://cytosorb-therapy.com/the-studies/case-of-the-week/