Hemosorption by a Column Adsorber Based on Hyper-Cross-Linked Styrene-Divinylbenzene Copolymer with Immobilized Lipopolysaccharide-Selective Ligand in Combined Intensive Care of Lung Cancer-Related Postoperative Acute Lung Injury (Case Report)

Abstract

Acute respiratory distress syndrome (ARDS) is a serious challenge in the contemporary reanimatology due to its prevalence, versatility of pathogenesis mechanisms, and continuously high mortality. The development of an uncontrolled cascade of systemic inflammation reactions, ‘cytokine storm’, followed by multiple organ failure (MOF) is an essential pathophysiological trigger of acute lung injury. Besides, critically ill patients are characterized by a relative intestinal ischemia, wherein, according to the ‘intestine-lung axis’ concept that treats intestinal and pulmonary epithelium as a continuous surface, translocation of bacteria and/or endotoxin directly into blood flow might occur. Extracorporeal removal of excessively produced inflammatory response mediators and endotoxin (bacterial lipopolysaccharide, LPS) from systemic circulation by selective hemosorption might represent a life-saving approach in sepsis.Purpose: to evaluate the efficacy of selective sorption in a combined therapy for acute lung injury related to postoperative injury after lung cancer surgery.Results. A single 4-hour selective sorption procedure in the combined therapy of a critically ill postoperative patient produced fast (within 24 hrs.) effects: decreased leukocytosis (the leukocyte count fell down from 32X109 to 13X109, L-1) and endotoxin activity (EAA — from 0.67 to 0.32, units), reduced blood plasma anti-inflammatory cytokine (IL-6 — from 1860 to 62, pg/ml) and procalcitonin (PCT — from 46 to 0.32, ng/ml), recovery of gas exchange, discontinuation of hemodynamic support with pressor amines as no longer needed (as early as 2 hours after sorption).Conclusion. The clinical case of a successful therapy including selective sorption based on hyper-crosslinked styrene-divinylbenzene copolymer with immobilized LPS-selective ligand warrants further clinical studies on the efficiency of a novel selective hemosorption column use to correct post-radical respiratory complications in oncological patients.