Sequential Extracorporeal Organ Support in Refractory Septic Shock: A Novel Combo Approach with Complete Recovery: A...

Refractory septic shock and multiple organ dysfunction syndrome (MODS) remain a critical challenge in intensive care because they are associated with high morbidity and mortality despite advanced care.

This case report describes the successful management of a 74-year-old female patient admitted with coronavirus disease 2019 (COVID-19) infection complicated by severe acute respiratory distress syndrome, refractory septic shock and MODS, including acute kidney injury and gastrointestinal bleeding. The patient received three sequential interventions, including continuous renal replacement therapy with the Oxiris hemofilter (Baxter International Inc, Deerfield, IL, USA) for cytokine/endotoxin removal, integrated extracorporeal CO₂ removal (ECCO₂R) via a single vascular access, and adjunctive IgM/IgA-enriched intravenous immunoglobulin therapy. The combined interventions resulted in a 74% reduction in C-reactive protein (325 → 85 mg/l), a 92% reduction in procalcitonin (28.3 → 2.3 ng/ml), normalization of hypercapnia (PCO₂ 107 → 48 mmHg) within 24h, and successful vasopressor discontinuation within 12 days. The patient recovered completely without any sequelae.

This case report demonstrates how coordinated extracorporeal organ support can produce beneficial effects in patients with refractory septic shock. The combined treatment provided renal, respiratory, and immunologic support through minimal vascular access and warrants further investigation in controlled trials.

Oxiris hemofilter rapidly improved haemodynamics Initiation of Oxiris-enhanced continuous renal replacement therapy (CRRT) was associated with a 40% reduction in norepinephrine requirement within 48 hours and a marked decline in inflammatory markers (C-reactive protein, CRP 325 → 188 mg/l; procalcitonin, PCT 28.3 → 9.1 ng/ml).Integrated Oxiris/ECCO ₂ R rescued severe hypercapnic failure: During rebound crisis (PCO₂ 107 mmHg; pH 7.01), integrated extracorporeal CO₂ removal (ECCO₂R) via the CRRT circuit enabled lung-protective ventilation and normalized PCO₂ to ~45-50 mmHg within 24 hours.Adjunctive IgM/IgA-enriched immunoglobulin supported recoveryAdding IV IgM/IgA-enriched immunoglobulin (5 ml/kg/day for 5 days) during rebound hyperinflammation was associated with further biomarker reduction (CRP 305 → 85 mg/l; PCT 15.8 → 2.3 ng/ml) and complete vasopressor discontinuation by day 12, suggesting potential synergy of sequential multi-targeted support.