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Interessenskonflikt
1) Cytosorb Register Planung
2) Studie Seraph Microbind: ExThera Medical
3) Fan von Arbeitsgruppe PD Dr. David, MHH
Cytokinelimination bei Sepsis
JanT Kielstein | Braunschweig
Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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
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.
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
From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810, 2016
From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810, 2016
Liste der FDA /EMA zugelassenen Medikamente zur Therapie der Sepsis
Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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
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
Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
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
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
biocompatible, highly porous polymer bead designed to capture and adsorb cytokines (~10-50 kDa)
Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient
DAVID et al. J Intensive Care 5:12, 2017
Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient
DAVID et al. J Intensive Care 5:12, 2017
Hemoadsorption by CytoSorb in septic patients: a case series (n=26)
KOGELMANN et al. Critical Care 21(1):74, 2017
Hemoadsorption by CytoSorb in septic patients: a case series (n=26)
KOGELMANN et al. Critical Care 21(1):74, 2017
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
Hemoadsorption by CytoSorb in septic patients: a case series (n=26)
KOGELMANN et al. Critical Care 21(1):74, 2017
From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA 315(8):801-810. 2016
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
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
……stay tuned
Cytokinelimination bei Sepsis
1) Sepsis – unmet medical need
2) Cytokine in der Sepsis
3) Adsorber
4) Alternative Technologien
Plasma exchange
SCHWARTZ et al. Journal of Clinical Apheresis
31:149–162, 2016
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
Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial
BUSUND et al. Intensive Care 28:1434–1439, 2002
Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial
BUSUND et al. Intensive Care 28:1434–1439, 2002
Therapeutic Plasma Exchange Decreases Levels of Routinely Used Cardiac and Inflammatory Biomarkers
TUTAREL et al. PLoS ONE 7(6): e38573, 2012
Effect of TPE on plasma levels and total removal of adipokines and inflammatory
markers SCHMIDT et al.
BMC Obesity 2:37, 2015
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
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
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
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
Safety and Performance Evaluation of the Seraph® Microbind® Affinity Blood Filter for Reducing Bacteremia in
Patients on Hemodialysis
I will survive
