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Decreasing the hemoadsorption adsorber change interval does not improve time to shock reversal in sepsis: A
Thomas Köhler1,2, Elke Schwier1, Eva Duppre1,3
1Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, Herford, Germany.
Introduction:
One goal of therapeutic efforts in sepsis/septic shock is rapid shock reversal that might be enhanced by adjunctive hemoadsorption by CytoSorb®. We hypothesized that shortening the time the adsorbers are used, reduces the time to shock reversal.
Methods:
In a retrospective study, we compared two groups of 16 and 17 patients with sepsis/septic shock treated with short change interval (sci) of 14.2 (12.9, 15.2) h/adsorber or long change interval (lci) of 21.7 (17.6, 24.0) h/adsorber.
Results:
Time to shock reversal, defined as the time from hemoadsorption start to the end of norepinephrine treatment, was similar between groups (sci: 5 (3.8, 12.7), lci: 10.8 (6.5, 18.5) days; p = 0.210) and did not correlate with the change interval. At baseline, the change interval correlated inversely with interleukin-6 (IL-6; p < 0.001). From baseline to day 5 the significant decrease of thrombocytes was more pronounced in the sci group.
Discussion:
Shortening the CytoSorb® change interval did not promote faster shock reversal, but imbalances in baseline imply patients in the sci group to have been sicker. Hemodynamic instability and high IL-6 levels prompted intensivists to use shorter change intervals. Possibly the increased number of adsorber binding sites was too low to be effective, or the observed spread between the short and lci was ineffective, or shortening of the change interval improved the outcomes of patients with higher risk profiles at baseline. The calculation of an effective hemoadsorption dose, be it by the amount of blood purified, or binding sites, or a combination hereof, remains speculative.
Trial Registration:
Not applicable.
