1)cytosorb register planung 2)studie seraph microbind: exthera …€¦ · interessenskonflikt...
TRANSCRIPT
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Interessenskonflikt
1) Cytosorb Register Planung
2) Studie Seraph Microbind: ExThera Medical
3) Fan von Arbeitsgruppe PD Dr. David, MHH
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Cytokinelimination bei Sepsis
JanT Kielstein | Braunschweig
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Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of
survival in human septic shock KUMAR et al. Crit Care Med. 34(6):1589-96, 2006
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From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810, 2016
SEPSIS: life threatening organ dysfunction caused ba a dysregulated host respone to infection.
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organ dysfunction: acute change in total SOFA Score >2 points consequent to infection.
From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810, 2016
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From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810, 2016
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From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810, 2016
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Liste der FDA /EMA zugelassenen Medikamente zur Therapie der Sepsis
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Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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Extracorporeal therapies in non-renal disease: treatment of sepsis and the peak concentration hypothesis
RONCO et al. Blood Purif 22(1):164-74, 2004
Excess pro- and anti-inflammatory
mediators removed by continuous combined therapies
Unselective high efficiency extracorporeal therapies might remove excess of pro- and anti-inflammatory mediators diminishing the amplified inflammatory response and the immunoparalisis induced by cell hyporesponsiveness
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The prognostic value of concomitant assessment of NT-proCNP, C-reactive protein, procalcitonin and
inflammatory cytokines in septic patients. TOMASIUK et al. Crit Care 18(3): 440, 2014
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Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter
randomized control trial (n=243) PAYEN et al. Intensive Care Med 41(6):975-84, 2015
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Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by
Gram-negative bacillus infection SAITO et al. PLoS One 12(3):e0173633, 2017
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biocompatible, highly porous polymer bead designed to capture and adsorb cytokines (~10-50 kDa)
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Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient
DAVID et al. J Intensive Care 5:12, 2017
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Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient
DAVID et al. J Intensive Care 5:12, 2017
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Hemoadsorption by CytoSorb in septic patients: a case series (n=26)
KOGELMANN et al. Critical Care 21(1):74, 2017
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Hemoadsorption by CytoSorb in septic patients: a case series (n=26)
KOGELMANN et al. Critical Care 21(1):74, 2017
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Efficacy and cardiovascular tolerability of EDD in critically ill patients: a randomized controlled study
KIELSTEIN et al. AJKD 43: 342-349, 2004
UF volume EDD 2.97 0.55 L/12h CVVH 3.28 0.39 L/24 h
Norepinephrine dose at 0 h EDD 0.47 0.11 CVVH 0.47 0.14 μg/kg/min Norepinephrine dose at 12 h EDD 0.45 0.12 CVVH 0.42 0.13 μg/kg/min
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Hemoadsorption by CytoSorb in septic patients: a case series (n=26)
KOGELMANN et al. Critical Care 21(1):74, 2017
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From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810. 2016
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Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using
a novel adsorbent (n=37) BERNARDI et al. Critical Care 20:96, 2016
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Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using
a novel adsorbent (n=37) BERNARDI et al. Critical Care 20:96, 2016
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……stay tuned
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Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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Plasma exchange
SCHWARTZ et al. Journal of Clinical Apheresis
31:149–162, 2016
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Plasma exchange in treatment refractory septic shock : Presentation of a therapeutic add-on strategy DAVID et al. Med Klin Intensivmed Notfmed 112(1):42-46, 2017
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Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial
BUSUND et al. Intensive Care 28:1434–1439, 2002
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Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial
BUSUND et al. Intensive Care 28:1434–1439, 2002
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Therapeutic Plasma Exchange Decreases Levels of Routinely Used Cardiac and Inflammatory Biomarkers
TUTAREL et al. PLoS ONE 7(6): e38573, 2012
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Effect of TPE on plasma levels and total removal of adipokines and inflammatory
markers SCHMIDT et al.
BMC Obesity 2:37, 2015
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Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational
single-centre study of 23 patients HADEM et al. BMC Anesthesiol 7;14(1):24, 2014
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Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational
single-centre study of 23 patients HADEM et al. BMC Anesthesiol 7;14(1):24, 2014
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The prognostic value of ADAMTS13 deficiency in septic shock patients involves interleukin-6 and is not dependent
on disseminated intravascular coagulation PEIGNE et al. Crit Care 18;17(6):R273, 2013
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Randomized, prospective, multicenter, open-label, controlled, parallel-group trial investigating the efficacy of add-on plasma-
exchange as an adjunctive strategy against septic shock with multiple organ dysfunction (EXCHANGE trial)
PI: PD Dr. Sascha David Hannover Medical School, GERMANY
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Safety and Performance Evaluation of the Seraph® Microbind® Affinity Blood Filter for Reducing Bacteremia in
Patients on Hemodialysis
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I will survive