Experience with the use of selective sorbents in complex intensive care of sepsis in patients after cardiac surgery

Introduction

The aim of the study was to evaluate the first experience with endotoxin adsorption in complex intensive care of critically ill patients with sepsis after heart surgery.

Methods

Eleven adult patients were studied. Patients were divided into two groups: undergoing Alteco LPS adsorption procedures (n = 6), and undergoing hemoperfusion using Toraymyxin columns (n = 5). Intensive therapy of sepsis in both groups included antibacterial therapy, hemodynamic and respiratory support, prevention of thromboembolism, stress ulcer prophylaxis, nutritive support, and studied extracorporeal techniques to endotoxin removal (two procedures for every patient).

Results

Endotoxin adsorption procedures were started on average at day 8 after surgery in patients with systemic inflammatory response syndrome and confirmed Gram-negative infection. As the result of procedures, hemodynamic indices improved in both groups while the dose of inotropic support decreased. Also we noted the improvement of oxygenating lung function. Positive dynamics of procalcitonin, endotoxin and inflammation mediator concentrations were noted. A favorable influence of studied procedures on the course of the infective process was confirmed by the dynamics of leukocyte count and the tendency to normalization of body temperature. Blood cultures taken several days after the procedures were negative. There was no deterioration of hemodynamic indices during and after procedures. No cases of thrombosis of the extracorporeal contour were noted. Data are presented in Figure 1 as mean ± SEM.

Figure 1

DHP-PMX, hemoperfusion with the use of Toraymyxin columns; MAP, mean arterial pressure; WBC, white blood cells; PLT, platelets; PCT, procalcitonin.

Conclusion

Both studied procedures are safe. Clinical studies should be continued to define the place of endotoxin adsorption in complex treatment of critically ill patients with sepsis.