Oxiris Filter Therapy in Vasoplegic Shock After Cardiac Surgery: A Single-Center Retrospective Study.

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Critical Care Medicine

Background:

• Vasoplegia is a severe complication post-cardiac surgery, often linked to endotoxin and cytokine release.
• Vasoactive inotropic support is crucial for managing vasoplegia but carries risks.
• Continuous renal replacement therapy (CRRT) is used to manage complications, but its role in improving hemodynamic stability in this context is under investigation.

Purpose of the Study:

• To evaluate the efficacy of the Oxiris hemadsorption filter during CRRT in improving hemodynamic stability in patients with vasoplegia after cardiac surgery.
• To compare the reduction in vasoactive inotropic score (VIS) between Oxiris and standard CRRT filters.

Main Methods:

• Retrospective, single-center study in a cardiothoracic intensive care unit.
• Included patients with vasoplegia (cardiac index ≥2.2 L/min/m² and norepinephrine ≥0.60 µg/kg/min) requiring CRRT within 24 hours post-cardiac surgery.
• Compared Oxiris hemadsorption filters against standard CRRT filters (control group).

Main Results:

• Fifty-eight patients were analyzed; the Oxiris group had a higher baseline VIS.
• The Oxiris group demonstrated a significantly greater reduction in VIS at 48 hours compared to controls (mean difference -18.9, p=0.045).
• Reduced norepinephrine dosage was the primary driver of the VIS reduction in the Oxiris group (mean difference -0.19 µg/kg/min, p=0.019).

Conclusions:

• Oxiris filter therapy during CRRT is associated with a significant reduction in the need for vasoactive inotropic support in post-cardiac surgery vasoplegia.
• The study suggests Oxiris hemadsorption may be a beneficial adjunctive therapy for managing vasoplegia.
• No significant differences were observed in other hemodynamic parameters, fluid balance, ICU stay, or 30-day mortality.