[The treatment of septic shock with continuous venovenous hemodialysis using high cut-off dialyzer in patient after immediate circulatory arrest].
The decreased immunity which occurs frequently in severely intoxicated patients may led to sepsis. The sepsis may be caused by bacterial toxins in unconscious patients with toxic coma which generate decreased immunity. Apart from the wide spectrum antibiotic therapy, crystalloids, colloids, vasopressin and corticosteroids, the renal replacement therapy may be useful in treatment of sepsis due to its complexes pathophysiology. Taking into account the role of cytokines in sepsis pathomechanism, the trials of treatment using high cut-off (HCO) membranes were performed in the recent years. These membranes remove molecules with mass up to 60 kDa, including cytokines typical for severe sepsis. The usefulness of continuous veno-venous hemodialysis--CVVHD with HCO dialyzer in the treatment of patient in septic shock and multiorgan damage--including damage caused by cardiac arrest was presented in the study. The concentration of IL-1P, IL-2, IL-4, IL-6, IL-10, IL-12, INF-alpha, INF-gamma, TGF-alpha in blood were determined before and after the 24-hours procedure. After the procedure the most evident decrease was observed for IL-4, 6, 10, 12 (17.3%, 31.8%, 83.4% i 22.3% respectively). During the following days the general status of patient improved gradually. The patient was discharged from the hospital after 20 days of hospitalization. His general condition was good, the values of inflammatory parameters were normal and the renal function was correct. There are very few studies describing HCO membranes effectiveness and they were performed on limited populations of patients. The presented case study may contribute to the discussion on the usefulness of dialysis with HCO membranes in the treatment of severely intoxicated patients complicated by serious sepsis resistant to standard antibiotic therapy.
Klinika Chorób Wewnetrznych, Nefrologii i Dializoterapii Wojskowy Instytut Medyczny, Warszawa. gkade@wim.mil.pl
Grzegorz
G
Kade
Klinika Chorób Wewnetrznych, Nefrologii i Dializoterapii Wojskowy Instytut Medyczny, Warszawa.
Magdalena
M
Wiśniewska
Klinika Chorób Wewnetrznych, Nefrologii i Dializoterapii Wojskowy Instytut Medyczny, Warszawa.
Arkadiusz
A
Lubas
Zakład Transfuzjologii Klinicznej, Wojskowy Instytut Medyczny, Warszawa.
Agnieszka
A
Rzeszotarska
Zakład Transfuzjologii Klinicznej, Wojskowy Instytut Medyczny, Warszawa.
Jolanta
J
Korsak
D000328:Adult; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D012769:Shock / Q000209:etiology / Q000628:therapy*; D012772:Shock, Septic / Q000150:complications / Q000628:therapy*