Abstract
BackgroundFor patients with primary brain injury, septic shock is especially dangerous due to the possibility of secondary cerebral damage. The key factor of sepsis-associated brain injury is inflammatory mediators, pathogen and damage-associated molecular patterns (PAMPs, DAMPs) release. Theoretically, blood purification may be beneficial for patients with primary brain injury due to its possibility for fast removal of inflammatory mediators.Case presentationWe report on six post-neurosurgery septic shock patients treated with combined blood purification (CBP), which included CRRT with high adsorption capacity membrane in combination with CytoSorb adsorber. Clinical improvement in the course of CBP was registered in all patients. Three patients had a stable clinical improvement; the other three patients had only a transient improvement due to underlying neurological and cardiac deficits aggravation. We observed septic shock reversal in four patients. The key observations of the case series are a significant decrease in MOF severity (measured by SOFA score) and in catecholamine need (not statistically significant). By the end of CBP we observed a significant decrease in blood lactate, PCT and IL-6 levels. Two patients demonstrated level of consciousness increase in the setting of CBP therapy measured by GCS and FOUR score.ConclusionThis case series demonstrates that CBP therapy may have a role for septic shock patients with primary brain injury.
Highlights
It has been described that septic shock is associated with a higher risk of mortality in ICU patients [1]
This case series demonstrates that combined blood purification (CBP) therapy may have a role for septic shock patients with primary brain injury
Clinical improvement during the course of CBP was registered in all our patients. 3 patients (CH, G, S) had a stable clinical improvement (MOF regress and lactate level decrease); the other 3 patients (P, K, M) had a transient improvement (vasopressor dose decrease (P, K), SOFA score and lactate level reduction (P, K, M))
Summary
It has been described that septic shock is associated with a higher risk of mortality in ICU patients [1]. It is important to be mindful of septic shock being the driver of the secondary brain damage in neurosurgical patients. For patients with primary brain injury, septic shock is especially dangerous due to the possibility of secondary cerebral damage. The key factor of sepsis-associated brain injury is inflammatory mediators, pathogen and damage-associated molecular patterns (PAMPs, DAMPs) release. Blood purification may be beneficial for patients with primary brain injury due to its possibility for fast removal of inflammatory mediators. Case presentation: We report on six post-neurosurgery septic shock patients treated with combined blood purification (CBP), which included CRRT with high adsorption capacity membrane in combination with CytoSorb adsorber. The key observations of the case series are a significant decrease in MOF severity (measured by SOFA score) and in catecholamine need (not statistically significant). Two patients demonstrated level of consciousness increase in the setting of CBP therapy measured by GCS and FOUR score
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