Observational case series: six neurosurgical patients with septic shock demonstrating clinical improvement after a combination of standard care and blood purification

• Published in: European journal of medical research Vol. 26; no. 1; p. 151
• Main Authors: Burov, A I, Abramov, T A, Kostritca, N S, Korotkov, D S, Danilov, G V, Strunina, Y V, Savin, I A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-12-2021; BioMed Central; BMC
• Subjects: Adsorption; Aged; Aged, 80 and over; Blood purification; Brain; Brain damage; Care and treatment; Case Report; Consciousness; Continuous renal replacement therapy; Cytokines; Edema; Female; Hemoadsorption; Hemoperfusion - methods; High adsorption capacity membrane; Humans; Hypotheses; Infection; Inflammation Mediators - therapeutic use; Inflammatory mediators adsorber; Injuries; Lactates; Male; Middle Aged; Mortality; Neurosurgical Procedures - adverse effects; Patients; Pulmonary embolisms; Sepsis; Septic shock; Shock, Septic - etiology; Shock, Septic - therapy; Surgical Wound Infection - etiology; Surgical Wound Infection - therapy; Thrombocytopenia; Septic shock; Hemoadsorption; Blood purification; High adsorption capacity membrane; Inflammatory mediators adsorber; Continuous renal replacement therapy
• ISSN: 2047-783X; 0949-2321; 2047-783X
• DOI: 10.1186/s40001-021-00614-7

For patients with primary brain injury, septic shock is especially dangerous due to the possibility of secondary cerebral damage. The key factor of sepsis-associated brain injury is inflammatory mediators, pathogen and damage-associated molecular patterns (PAMPs, DAMPs) release. Theoretically, blood purification may be beneficial for patients with primary brain injury due to its possibility for fast removal of inflammatory mediators.
We report on six post-neurosurgery septic shock patients treated with combined blood purification (CBP), which included CRRT with high adsorption capacity membrane in combination with CytoSorb adsorber. Clinical improvement in the course of CBP was registered in all patients. Three patients had a stable clinical improvement; the other three patients had only a transient improvement due to underlying neurological and cardiac deficits aggravation. We observed septic shock reversal in four patients. The key observations of the case series are a significant decrease in MOF severity (measured by SOFA score) and in catecholamine need (not statistically significant). By the end of CBP we observed a significant decrease in blood lactate, PCT and IL-6 levels. Two patients demonstrated level of consciousness increase in the setting of CBP therapy measured by GCS and FOUR score.
This case series demonstrates that CBP therapy may have a role for septic shock patients with primary brain injury.