Blood Purification Methods Research Articles

Effect of Different Blood Purification Methods on Residual Renal Function in Maintenance Hemodialysis Patients

Objective: This study aims to evaluate the efficacy of different blood purification methods in protecting residual renal function (RRF) in patients with maintenance hemodialysis (MHD). Methods: The study selected 50 patients receiving MHD between September 2023 and September 2024. Using the random number table method, patients were divided into the control group and the study group, each with 25 participants. The control group received hemodiafiltration, while the study group was treated with hemodialysis plus hemoperfusion. The RRF measures of the two groups were compared. Results: There were significant differences in the RRF measures (P < 0.05). Conclusion: Combined hemodialysis and hemoperfusion therapy can effectively improve the RRF index of MHD patients with a significant curative effect.

Septic Hyperinflammation-Is There a Role for Extracorporeal Blood Purification Techniques?

This manuscript investigates the role of extracorporeal blood purification techniques in managing septic hyperinflammation, a critical aspect of sepsis characterized by an uncontrolled immune response leading to multiorgan dysfunction. We provide an overview of sepsis, focusing on the dynamics of immune response, the involvement of neutrophils, and the role of the endothelium in the disease's progression. It evaluates the effectiveness of various blood purification methods, including high-cut-off membranes, high-volume hemofiltration, adsorption techniques, and albumin dialysis, in removing cytokines and endotoxin and improving hemodynamic stability. Despite some very promising results, we conclude that the current evidence does not strongly support these techniques in significantly improving survival rates in septic patients, clearly underlining the need for further research.

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP.

In septic shock patients, pathogens and excessive endotoxins continuously overstimulate the host's immune system with a cytokine storm that can lead to multi-organ failure and even mortality. Various types of extracorporeal blood purification treatments have recently been introduced to remove excessive endotoxins and cytokines. Herein, we compared the clinical efficacy of two blood purification methods, PMX-HP and AN69-oXiris, and discussed their detailed indications according to disease severity. From December 2016 to April 2023, patients who underwent emergent surgery due to septic shock secondary to peritonitis and subsequently received blood purification treatment with AN69-oXiris or PMX-HP were enrolled. Propensity score (PS)-matching was conducted to adjust for baseline characteristics between the two groups, and the changes in clinical parameters and outcomes were compared. Clinical outcomes were assessed in subgroups of patients who underwent PMX-HP treatment divided according to SOFA scores into low (0-7), intermediate (8-13), and high (> 13) disease severity groups. Forty patients received blood purification therapy with either PMX-HP or AN69-oXiris during the study period. After 1:2 PS matching, six patients in the AN69-oXiris group and 12 patients in the PMX-HP group were finally analyzed. Vasoactive-inotropic scores (VISs) decreased in both groups after 48 h of treatment compared to the baseline values, but the change in VISs was more pronounced in the PMX-HP group {-57.6 [interquartile range (IQR) = -166.4 - (-10)] vs. -22.9 [IQR = -64-0], respectively, p = 0.041}. Decreases in cardiovascular SOFA scores were significantly pronounced in the PMX-HP group [-1.5 (IQR = -4 - 0) vs. 0 (IQR = -1 - 1), respectively, p = 0.035]. The 7-day mortality rate was significantly lower than the predicted mortality rate in a subgroup analysis of patients treated with PMX-HP in both the low disease severity group and the intermediate disease severity group. PMX-HP and AN69-oXiris could be therapeutic options for refractory septic shock patients with intra-abdominal origins, especially after the surgical elimination of the infectious sources. A tailored modality choice that takes into account patient characteristics, such as disease severity and cost burden, could optimize the efficacy of this strategy.

New directions of scientific research and clinical practice in the field of extracorporeal hemocorrection in patients with multiple organ dysfunction: a review

INTRODUCTION: Due to the COVID-19 (infectious disease caused by the SARS-CoV-2 virus) pandemic, we had to take a completely different approach to the nature of critical conditions. The pandemic also made us reconsider many views about it. Moreover, that contributed to the development of new practical approaches for treatment and prevention, including the ones in the field of extracorporeal hemocorrection. OBJECTIVE: Methods for purification of blood and plasma began to be considered as an independent link for the treatment of organ disorders or as a part of extracorporeal support for the life support of the body. MATERIALS AND METHODS: The article consists of three sections: a description of the role of extracorporeal hemocorrection methods in intensive care, their classification and main characteristics; the concept of sequential targeted extracorporeal therapy for a treatable symptom in sepsis; extracorporeal hemocorrection as part of the concept of extracorporeal life support. This article uses literary sources published from January 1, 2022 to July 1, 2023. Materials related to COVID-19 and other specific pathologies (poisoning, acute liver failure, itching, systemic diseases, etc.), requiring separate discussion, are intentionally excluded. RESULTS: Technologies in extracorporeal hemocorrection provide support and/or replacement of organ functions; restoration of body resistance and balance between inflammatory and anti-inflammatory response; restoration of body tolerance (metabolism and regeneration). Nevertheless, despite the convincing pathophysiological rationale for the use of these methods in critical conditions, evidence of its effectiveness is limited. Current trends indicate that future research should be primarily aimed at finding biomarkers that can simultaneously designate specific biological processes; characterize different subgroups of patients; allow targeted choice for the method of therapy. The modulation of biomarkers under the influence of this therapy can show its effectiveness for this particular subgroup of patients at this stage of the disease. CONCLUSIONS: Methods of extracorporeal blood purification should be aimed at prevailing biological processes, at this stage of pathogenesis, and, accordingly, evaluated by the effectiveness of the impact on these processes.

Research progress of combination therapy of blood purification in the treatment of paraquat poisoning

Paraquat is a kind of herbicide effective in weeding, characterized by low cost and environmentally friendly property, which is widely used in agricultural weeding. However, the high toxicity of paraquat can cause damage to the lungs, liver, kidney, and other organs after oral intake. Worse still the patient will develop pulmonary fibrosis and will die of respiratory failure. At present, there is no specific detoxification drug for patients poisoned by paraquat. Based on the current therapeutic schedule, blood purification is considered to be the most effective method for the removal of paraquat-related toxins. However, there is a lot of controversy over the combined method. This paper expounds on the poisoning mechanism of paraquat and the advantages and disadvantages of different blood purification methods, aiming to find a specific scheme that can be applied to the clinic and improve the organ function and prognosis of patients.

Application of blood purification technology in severe fever with thrombocytopenia syndrome

ABSTRACT Objective: The purpose of this paper is to summarize the blood purification technology applied in patients with severe fever with thrombocytopenia syndrome (SFTS) in the clinical treatment effect. Methods: The medical records of 96 patients with severe SFTS admitted to Weihai Municipal Hospital affiliated to Shandong University from May 2014 to November 2019 were retrospectively analyzed, and they were divided into survival group and death group. The differences in basic data test indexes and treatment method selection during intensive care unit (ICU) admission between the two groups were significantly analyzed, and the indexes with statistically significant differences were included in the multivariate logistic regression analysis related to prognosis. Results: There were no statistically significant differences in age, sex composition, white blood cell count, platelet count, creatine kinase (CK), activated partial thromboplastin time (APTT), serum creatinine and hemofiltration renal replacement therapy between the survival group and the death group. There were statistically significant differences between the two groups in viral load bilirubin and the treatment methods of plasma exchange (PE) or hemoperfusion (HP). Plasma exchange group (78 cases), hemofiltration group (12 cases), hemoperfusion group (6 cases), plasma exchange and hemoperfusion and other blood purification treatment of the prognosis were statistically different. Conclusions: Compared with the three blood purification methods, plasmapheresis has a significant effect on virus removal, improvement of coagulation function and survival rate in patients with severe SFTS. Hemofiltration plays a role in removing inflammatory mediators, replacing renal function, maintaining electrolytes and acid-base balance, but not in removing viruses.

Methods of Extracorporeal Hemocorrection in Sepsis (Review)

Sepsis and septic shock remain a major problem in critical care medicine being the most common causes of death in the intensive care unit. Currently, such methods of extracorporeal blood purification as hemodiafiltration, high-volume hemofiltration, high cut-off (HCO) membrane hemofiltration are among preferable options for treatment of severe systemic disorders and pathological conditions including sepsis.The purpose of the review is to show the potentialities and prospects of the use of various extracorporeal hemocorrection methods, including those that are commonly employed in medical practice, and novel ones, either recently developed, or still under the development in experimental settings according to sepsis patho-physiology. The selected 82 papers represent comprehensible clinical and experimental data from the literature of the last five years and several earlier publications remained of current interest in a medical practice.The review presents current methods of extracorporeal hemocorrection (EHC) in patients with sepsis. The clinical pathophysiology of sepsis is described in relation to treatment options that target endotoxemia and «cytokine storm». We consider commonly used EHC methods (hemodiafiltration, high-volume hemofiltration, high cut-off membrane hemofiltration and others) and novel promising technologies that include extracorporeal kidney support device, immune support system, leukocyte inhibition module, and artificial spleen, which have been recently developed and are still under investigation in the intensive care.Conclusion. Currently, EHC methods are increasingly used not only to support renal function, but also as pathogenetic therapy option for multiple organ support and immunomodulation by reducing the level of cir-culating inflammatory mediators. Exploration of novel extracorporeal blood purification techniques for the pathogenetic treatment of patients with sepsis seems encouraging and promising.

Effect of participation of typical clinical pharmacists in patient medication in ICUs with different approaches: An investigation and case analysis

PurposeTo investigate and study the impact on patient recovery of pharmacists’ participation in the medication guidance and intervention of patients in intensive care units (ICUs). Patients and methodsWe analyzed the drug use and typical cases of patients in the ICU of our hospital during clinical pharmacists' consultations or active monitoring from July 2019 to December 2020. This study included a total of 292 cases, which were distributed in the following eight areas: drug adjustment based on patients with hepatic and renal insufficiency,optimisation of treatment regimens based on drug interaction, identification and intervention based on adverse drug reactions, selection of blood purification methods based on drug intoxication, infusion access adjustment based on drug compatibility, drug adjustment based on genetic testing, antibiotic dose adjustment based on pharmacokinetics/pharmacodynamics (PK/PD) and others. The main observation indexes included consultation opinion efficiency rates and acceptance rates. The acceptance rate is calculated according to the acceptance of the clinical pharmacist's opinion by the competent doctor (fully accepted, partially accepted, not accepted). Calculate the efficiency rate according to the effect of the intervention measures. Definition of effectiveness: improvement of therapeutic effect of drugs; Avoid the occurrence of potential adverse drug reactions; Avoid the occurrence of potential drug compatibility reaction (for example, adjust the infusion sequence to avoid turbidity and sedimentation in the infusion pathway). ResultsThe results showed that clinical pharmacists participated in 292 cases of consultation or active monitoring of patients in the hospital's ICU based mainly on specific patient medications, drug interactions, adverse drug reactions, blood purification therapy, drug compatibility/venous infusion pathways, blood drug concentrations/drug–gene monitoring, drug PK/PD, etc. The doctor in charge acceptance rate of the consultation advice was 88.46% (completely accepted by 59.3%, partially accepted by 30.8%), and the effective rate of the consultation was 80.2%. ConclusionBased on different purposes of intervention, the acceptance rate and efficiency rate were different. The efficiency rate with complete acceptance was significantly higher than that with partial acceptance or non-acceptance. The intervention opinions proposed by a comprehensive team in which pharmacists participate are of great help to patients and can reduce adverse reactions and medication risks. The higher the acceptance rate of their opinions, the higher the effective rate.

An inquiry into the treatment of sepsis using plasma exchange therapy: A systematic review and meta-analysis.

Sepsis is a potentially lethal condition that occurs when the body's response to infection damages tissue and organs. The production of inflammatory mediators typically assists in defending the body against infection; however, an overreaction to inflammation can cause coagulation problems, vascular endothelial damage, and organ hypoperfusion. Blood purification methods, such as plasmapheresis, can effectively remove inflammatory mediators from plasma. The purpose of this meta-analysis was to explore the efficacy of plasma exchange for sepsis treatment as noted in recent studies. The authors searched the Pubmed (Medline), Cochrane Central Register of Controlled Trials (The Cochrane Library), Embase (Ovid), and Scopus databases and included controlled clinical studies that compared plasmapheresis or plasma filtration with conventional treatment in patients with severe sepsis. The Newcastle-Ottawa Scale literature quality assessment tool was used to assess the risk of bias. The primary study outcome was all-cause mortality. The random effects model was adopted for conducting the meta-analysis. Among the 1013 records found, the study included 5 trials, all of which carried a low risk of bias. The use of plasmapheresis was associated with a longer stay in the intensive care unit (odds ratio [OR], 0.85, 95% confidence interval [CI], 0.39-1.32, heterogeneity [I2 ]=0%), a significant reduction in all-cause mortality (OR, 0.54, 95% CI, 0.33-0.89, I2 =70%), and reduced mortality (OR, 0.29, 95% CI, 0.13-0.67, I2 =0%) in adults; the results for children differed from this (OR, 0.79, 95% CI, 0.36-1.72, I2 =89%). Four trials reported no adverse events; one trial reported an adverse event related to plasma exchange, including an instance of hypotension in one patient. Plasmapheresis appeared to be an effective treatment for patients suffering from sepsis. A large number of additional randomised controlled trials are needed to confirm this finding.

ACUTE BLOOD PURIFICATION METHODS IN INTENSIVE CARE OF COMPLICATIONS AFTER CARDIAC SURGERY.

<h3>Objective</h3> Complications after cardiac surgery have serious negative consequences, prolonging intensive care (ICU) stay days and significantly increasing costs. Prevention and treatment of complications after cardiac surgery is a serious problem. According to numerous authors, the incidence of complications after cardiac surgery varies from 10 to 60%. The most common and prognostically significant complications are bleeding, acute kidney injury and infection. Advances in cardiac surgery have led to a reduction in the overall mortality associated with open-heart surgery, however, still extremely high among patients with complications. Impaired renal function, or active infectious process, sepsis has significant prognostic consequences which are the cause of up to 40% of deaths. As a solution may serve various methods of blood purification. In recent decades, the blood purification method of choice in the therapy of numerous pathological conditions is resistant to traditional therapy. This study details one centre's experience of acute blood purification application in the ICU. <h3>Materials and Methods</h3> Structural analysis of acute extracorporeal blood purification methods application to patients in ICU. The period from 2015 to the 2021 year. <h3>Results and Discussion</h3> For the period from 2015 to 2021 more than a thousand patients underwent extracorporeal methods of blood purification due to complications after cardiac surgery or the severity of the condition. Throughout the period effectiveness and safety were assessed. Blood purification is an option of therapy for numerous complications in the postoperative period(acute kidney injury, Systemic inflammatory response reaction syndrome, sepsis cytokine storm, fluid overload). We have a positive experience with extracorporeal blood purification application to patients after different types of cardiac surgery (open valve surgery, surgery of myocardium revascularization, implantation of left ventricular assist device, heart and lungs transplantation, transcatheter manipulation) in the immediate postoperative period. The structure of procedures and patients' characteristics are shown in table 1. <h3>Conclusion</h3> Acute extracorporeal blood purification methods are a significant option in therapy of complications after cardiac surgery. Procedures are effective and safe. This direction requires further development and study.

Plasma exchange and COVID 19

Plasma exchange and COVID 19

Fibronectin: structure, functions, clinical significance (review)

Plasma fibronectin is a high molecular weight adhesive glycoprotein. There are two types of fibronectin: plasma (soluble) and cellular derived (insoluble). Electron microscopy revealed two types of structural organization of fibronectin: compact and expanded. In solution, fibronectin has a compact conformation, and after binding to certain substrates (collagen, fibrin, heparin), it is expanded. Plasma fibronectin is one of the main opsonins of blood plasma in relation to the “targets” of phagocytosis of a predominantly non-bacterial nature, as well as to some types of bacteria. For the treatment of septic processes, as well as respiratory distress syndrome of adults with severe fibronectin deficiency, plasma cryoprecipitate is used – a donor plasma preparation containing a large amount of plasma fibronectin (more than 2 mg/ml). It was proposed to replenish the level of fibronectin in patients with sepsis and other conditions that cause plasma fibronectin deficiency with the help of donor freshly frozen plasma. Transfusion of large volumes of freshly frozen plasma (up to 1000–1500 ml) to patients effectively eliminates the deficiency of plasma fibronectin. The concentration of plasma fibronectin in the blood significantly decreases after the addition of severe infectious processes to hematological diseases, as well as acute DIC syndrome. Extracorporeal methods of blood purification – selective plasmapheresis – have been developed to correct immunocomplex and fibronectin-complex pathology. Two variants of selective plasmapheresis have been proposed: the method of heparinocryoprecipitation of plasma proteins and the method of heparinocryofractionation. In 1987, a plasma heparin precipitate was proposed as a source of fibronectin for the treatment of patients with trophic skin lesions. In 1992, a new method was proposed for obtaining blood preparations with a high concentration of plasma fibronectin from patients themselves (heparin cryofractionation). Autofibronectin preparations obtained by such methods are effective in the local treatment of trophic ulcers in 90–93% of cases. The proposed drugs are safe against infection of patients with infectious diseases transmitted through the blood.

MO353: Extracorporeal Blood Purification of Complications After Aortic Valve Replacement. Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement

Abstract BACKGROUND AND AIMS Complications after cardiac surgery have serious negative consequences, prolonging the average ICU stay days and costs. Prevention and treatment of complications after aortic valve replacement is a serious problem. According to numerous authors, the incidence of complications after aortic valve replacement varies from 10 to &amp;gt;60% of cases. Development of complications is associated with a higher hospital mortality rate, the risk of infection and a more complex course of the disease. Advances in cardiac surgery have led to a reduction in the overall mortality associated with open-heart surgery; however, it can still exceed 40% among those patients who develop a postoperative complication and can reach 50% in patients requiring extracorporeal blood purification therapy. Impaired renal function or active infectious process has significant prognostic consequences, which are the cause of up to 40% of deaths. The aim of this work is to structure or compare complications in immediate postoperative period after aortic valve replacement by the surgical and transcatheter method. METHOD Retrospective analysis of 267 medical records. All patients in study were after aortic valve replacement, hospitalized in JSC NSCC Nur-Sultan, Kazakhstan, from 1 January 2020 to 31 October 2021. A total of 127 patients SAVR, 137 patients TAVR. Of those, 3 patients were excluded from the study due to chronic haemodialysis. Inclusion criteria: informed consent to participate in research. Age is&amp;gt;18 years old. Prosthetics of the aortic valve by the SAVR or TAVR methods. Treatment of postoperative complications by the extracorporeal blood purification methods. Exclusion criteria: refusal to participate in research. Age is &amp;lt;18 years old. Chronic dialysis. Active bleeding. The patients were divided into two groups: group 1—patients after aortic valve replacement by the TAVR method and group 2—patients after open surgery aortic valve—SAVR. Indications for extracorporeal blood purification methods: acute kidney injury (AKI), acute liver injury, the systemic inflammatory response syndrome (SIRS) and cytokine storm. RESULTS Period from 2020 to 2021. TAVR group—137 patients, male―65 (47.45%), female—72 (52.55%), the average age of patients was 69.2±11.16 years. In the SAVR group, there were 127 patients, of which male 43 (33.9%) and female 84 (66.1%), the average age was 47.04 ± 13.67 years. CONCLUSION Complications and mortality rate are more common after open surgery SAVR than after TAVR. Extracorporeal blood purification methods are required after an open valve replacement. Extracorporeal blood purification methods are an effective way to treat complications such as AKI and SIRS after aortic valve replacement.

History of the research laboratory (medicinal and environmental toxicology) of the Military medical academy named after S.M. Kirov

This paper presents the history of the formation of the Research Department of the Experimental Medicine of the Research Center of the Military Medical Academy named after S.M. Kirov. The department is the only division of the academy that conducts experiments on animal models and field tests using laboratory animals in the interests of the Armed Forces of the Russian Federation. The paper also presents the main scientific achievements and development prospects of one of the three laboratories of the department Research Laboratory of Medicinal and Environmental Toxicology. In the direction of drug toxicology, the laboratory staff worked for 15 years in cooperation with the Scientific Center of the Russian Academy of Sciences (Pushchino) on the problems of perfluorocarbon-based blood substitutes. The results of the study helped deepen the understanding of the mechanisms of the physiological activity of perfluorocarbon emulsions and the expansion of the areas of clinical application of perftoran. The ecotoxicological direction of scientific research is represented by two large-scale cycles of scientific studies. The first was devoted to the medical support of oil refining to increase the protection of personnel who have been professionally exposed to toxic chemicals from the damage caused by chemical accidents. The second area of environmental research, which has been significantly updated in recent years, is devoted to the study of remote environmental and biomedical consequences of the use of chemical weapons by the US Army in the period from 1966 to 1972 in Vietnam. In recent years, the laboratory has focused on problems related to the search and development of new radiation countermeasure agents including biotechnological products and their compositions. Studies are also being conducted to improve the complex therapy of patients with sepsis, in which methods of extracorporeal blood purification are used in the treatment. These works are relevant for military and civilian health care and are performed in cooperation with the departments of the academy and several leading research organizations in St. Petersburg.

MO373EXPERIENCE OF EXTRACORPOREAL BLOOD PURIFICATION METHODS APPLICATION TO PATIENTS WITH SEVERE COVID - 19

Background and AimsIn the rapidly changing conditions of life due to the COVID - 19 pandemic, the medical society around the world have faced with the question of treatment previously unknown, multi-faceted and insidious infection. The coronavirus infection has forced doctors to reconsider the tactics of intensive care patients in critical condition. To date, overall mortality rate from COVID – 19 varied from 8.11 to 120.85 per 100.000 population (Johns Hopkins University mortality analyses). Mortality rate in extremely severe cases exceeds 60% - 78% (Yang et al., Lancet Respiratory Medicine, 2020. Zhou et al., Lancet, 2020).We would like to share our clinical experience of extracorporeal blood purification methods application to patients in ICU with various clinical manifestations, as well as the presence of comorbid pathology.MethodWe conducted a retrospective analysis of 239 medical records of patients hospitalized in the ICU of JSC NRCSC Nur-Sultan, Kazakhstan because of severe course of COVID 19. Period of hospitalization from 16.06.2020 to 29.09.2020, the total number of beds - 97, in the ICU - 25.ResultsThe total number of patients with COVID -19 - 239 patients. In ICU -67 patients. Patients required in renal replacement therapy (RRT) – 31 patients.Among patients on RRT males-28 (90.3%) - female-3 (9.67%).Mean age-60 years.Distribution of the comorbid pathology.NOComorbid pathologyN = 31Diabetes insipidus10 (32,2%)Sepsis5 (16.1%)MODS6 (19.3%)Acute kidney damage 2 (KDIGO 2018)9 (29%)Acute kidney damage 3 (KDIGO 2018)5 (16.1%)Anuria11 (35.48%)Acute respiratory failure 324 (77.4%)ARDS19 (61.29%)Artificial lung ventilation28 (90.32%)COPD3 (9.67%)Hypertension9 (29%)Ischemic heart disease6 (19.3%)Obesity9 (29%)Cytokine storm19 (61.29%)ECMO15 (48.38%)LVAD1 (3.22%)Gastric ulcer1 (3.22%)Indications for RRT: acute respiratory failure in the absence of heart failure or fluid overload; presence of diffuse alveolar damage (DAD) (detected by high-resolution CT); PaO2 / FiO2 ≤ 300 mm Hg Duration:> 6-24 hours per column with a blood flow rate of 80-120 ml/min. In addition, indications for the urgent start of extracorporeal treatment are:signs of severe coronavirus infection (respiratory rate ≥ 30 per minute and / or blood oxygen saturation ≤ 93% and / or PO2/FiO2 index ≤ 200 mmHg;detection of lung lesion progression using one of the imaging methods ≥10% per day;progressive increase in the level of inflammatory markers (CRP, IL-6, etc.).The duration of hospitalization in the ICU – 12.54 days.Combinations and duration of the procedures.Name of the procedure(n)Duration (in hour)HP HA330 + CVVHF/CVVHDF 2+1+1 (n=33)> 1224 чHP Cytosorb© + CVVHF/CVVHDF 1+1+1(n=5)> 24 чHP HA330II+ CVVHF/CVVHDF 2+1+1 (n=31)> 1224 чPE + CVVHF/CVVHDF 2+1+1(n=7)> 624 чHP2+1+1(n=14)> 3-6 чFootnote: combinations and duration of use are in accordance with the recommendations of Ronco C. et al. (2020).Laboratory data - Leukocyte, CRP, Interleukine, procalcitonin, Creatinin, presepsin in dynamics.Laboratory dataBefore blood purificationAfter the 1st procedureAfter the 2nd procedureAfter the 3d procedurep valueLeukocyte15.3013.3110.688.230.01CRP17.9116.1214.1013.020.02Il - 6260.77205.82201.188188.90.027PCT26.5812.134.345.560.01Creat2.331.771.891.340.01Presepsin2420.242788.811783.562063.410.18General Mortality – 37 from 239 (15.5%)Mortality in ICU – 37 from 67 (55.2%)According to literature review, the mortality rate of patients with severe COVID - 19 in the ICU (Fawad Rahim et al, Cureus . 2020 Oct 12;12(10):e10906. doi: 10.7759/cureus.10906.) without the use of CRRT exceeds 70-77%.)ConclusionOur analysis had showed a positive effect of early use (1 day of hospitalization) of extracorporeal methods of blood purification, on a decreasing of inflammation indicators, as well as positive survival rate of patients with severe COVID-19 course in ICU conditions.

Extracorporeal Strategies in Sepsis Treatment: Role of Therapeutic Plasma Exchange

Mortality in sepsis remains high. Various techniques for extracorporeal cytokine removal have been investigated as additional therapeutic measures in sepsis and septic shock. To summarize a selection of extracorporeal blood purification techniques, with a special focus on therapeutic plasma exchange, and their current evidence in clinical use. Non-systematic literature review. Various extracorporeal blood purification techniques with different levels of evidence regarding cytokine removal, vasopressor sparing effects and reduction of mortality are currently in clinical use. Most extensively studied modalities include high-volume hemofiltration/dialysis with and without high cut-off filters a well as hemoadsorption techniques (including CytoSorb, and polymyxin-B filters). Despite partly encouraging observations regarding removal of inflammatory cytokines and hemodynamic stabilization, results from randomized studies did not show an effect on survival. Due to use of donor plasma as substitution fluid, therapeutic plasma exchange represents the only modality able to additionally replace protective and consumed factors. The use of extracorporeal blood purification methods cannot be recommended for sepsis patients outside of clinical trials given the current lack of evidence of their efficacy. Future investigations should aim to homogenize the studied patient collective in respect to clinical sepsis severity, time point of intervention and different inflammatory (sub-)phenotypes.

Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery

Background: To date, sepsis remains one of the main challenges of intensive care in pediatrics. Newborns with low birth weight and infants with chronic diseases and congenital disorders are particularly at risk. The incidence of infectious complications in pediatric cardiac surgery is known to be approximately 15–30%. The main etiological factor of sepsis is endotoxin. Aim: To evaluate the efficiency and safety of polymyxin (PMX) B-immobilized column-direct hemoperfusion in complex intensive therapy of sepsis in children after cardiac surgery with cardiopulmonary bypass. Design: Prospective cohort study. Methods: This study enrolled 15 children, aged 9–96 months, with congenital heart diseases and with body weights of 6.2–22.5 kg. The criteria for admission were body weight >6 kg and clinical and laboratory signs of sepsis (microbiological analysis, procalcitonin [PCT] >2 ng/mL, and endotoxin activity assay [ЕАА] >0.6). Intensive care included inotropic and vasopressor support, mechanical ventilation, broad-spectrum antibiotic therapy, and PMX hemoperfusion procedures. Extracorporeal therapy was initiated within 24 h following the sepsis diagnosis. Every patient underwent 2 hemoperfusion sessions with the use of a PMX B-immobilized column; the session duration was 180 min. Results: We noted improvements in hemodynamic parameters, oxygenation index, and laboratory signs of sepsis, with decreases in the endotoxin concentration according to the EAA, PCT, and presepsin levels. The 28-day survival of the patients in this severely affected group was 80%. Main Conclusion: The inclusion of extracorporeal methods of blood purification, aimed at the selective elimination of circulating endotoxin, in the treatment of sepsis increases the survival rates of children after open heart surgery. Second Conclusion: The obtained results of sepsis therapy with PMX hemoperfusion in children after cardiac surgery enable us to suggest the sufficient safety and efficiency of the procedures in this category of severely affected patients.

Extracorporeal techniques for blood purification in sepsis: an update

Despite ongoing development, mortality in sepsis remains considerable. Various techniques for extracorporeal cytokine removal have been described, but evidence remains conflicting. The aim of this article is to summarize currently used extracorporeal blood purification techniques and their evidence. Non-systematic literature review RESULTS: There are currently various blood purification techniques used with different levels of evidence regarding cytokine removal, vasopressor sparing effects and reduction of mortality, including high-volume dialysis with and without high cut-off filters, special adsorption filters (including CytoSorb®, CytoSorbents Europe, Berlin, Germany, and polymyxin‑B filters). There is development regarding therapeutic plasma exchange. For some blood purification techniques such as combined plasma filtration and adsorption, multicentric randomized studies found anegative effect on survival. Despite atheoretical rationale, the use of blood purification methods cannot be recommended for sepsis patients due to the lack of evidence of their efficacy. Heterogeneous inflammatory responses in sepsis render conduction of larger trials difficult. Thus, future studies should cautiously identify appropriate sepsis subtypes to be included. Available techniques should be chosen as individualized complementary treatments and not as competing systems.

Extracorporeal blood purification in the complex treatment of the novel coronavirus infection: the review of opportunities

The objective : to provide pathogenetic justification for the need for extracorporeal blood purification in the new coronavirus infection. Results : the article analyzes guidelines and the first experience of using extracorporeal methods in the new coronavirus infection in different countries. It has been demonstrated that methods of extracorporeal blood purification have complex pleiotropic (multiple) effects and can quickly normalize the level of cytokines and other pathogenic factors, thereby preventing/reducing the severity of organ disorders. The article specifies the criteria for choosing an extracorporeal method, as well as indications for its early and late use.

Influence of the extracorporeal detoxication methods on the levels of nonessential amino acids in the blood plasma of patients with sepsis (Communicated by Corresponding Member Nikolay S. Serduchenko)

Some disadvantages of the extracorporeal blood purification (EBP) methods as reducing plasma levels of different important metabolites are described. Disorders of amino acid metabolism in sepsis are manifested into microcirculation interruptions, a decreased immune response and an increased mortality. The aim of the study is to investigate the EBP influence on the levels of nonessential amino acids in the blood plasma of patients with sepsis. 28 patients diagnosed with “sepsis” were selected. Standard treatment protocols of plasma filtration, hemofiltration and hemadsorption with various sorbents were used. A significant decrease in the levels of asparagine, phosphoethanolamine, proline; α -aminobutyric acid showed a significant increase in these levels in patients who underwent “Proteasosorb” sorbent hemadsorption. A significant decrease in the levels of ornithine, aspartic acid, 3-methylhistidine, 1-methylhistidine in patients treated with hemofiltration was found. The EBP methods significantly influence the amino acid metabolism.