Sepsis Management with a Blood Purification Membrane: European Experience
Sepsis Management with a Blood Purification Membrane: European Experience
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DOI：
10.1159/000499355
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发表时间：
2019-01-01
影响因子：
3
通讯作者：
Harenski, Kai
中科院分区：
文献类型：
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作者：
Pickkers, Peter;Vassiliou, Timon;Harenski, Kai
背景：感染性休克是急性肾损伤(AKI)的主要原因。内毒素和细胞因子水平与AKI的发生和严重程度有关，可使用不同的血液净化设备将其从循环中移除。Oxiris就是这样一种设备，它是一种中空纤维净化过滤器，可以清除内毒素和细胞因子。由于证据有限，指南中目前并不提倡该设备的临床应用。然而，诊所确实经常使用这种设备，迫切需要指导它在有或没有AKI的脓毒症中的应用。方法：采用改进的德尔菲法对欧洲专家对Oxiris的适应症(S)、开始和停用标准以及成功措施的意见进行整理。结果：根据危重护理和败血症处理领域的已知临床专业知识以及他们使用Oxiris血液净化设备的经验，选出了一个由14名参与者组成的小组。参与者使用不同的标准开始使用Oxiris对有和没有AKI的脓毒症患者进行治疗。感染性休克合并AKI是优先患者群体，Oxiris用于迅速改善血流动力学参数。在72小时内达到血流动力学稳定是决定治疗成功的关键因素。结论：在缺乏既定指南的情况下，中空纤维净化装置(如Oxiris)的使用者可能受益于选择患者、开始和终止治疗以及衡量成功的标准化方法。迫切需要以随机临床试验的形式提供进一步的证据。(C)2019年作者(S)由S.Karger AG，巴塞尔出版
Background: Septic shock is a leading cause of acute kidney injury (AKI). Endotoxins and cytokine levels are associated with the occurrence and severity of AKI, and different blood purification devices are available to remove them from circulation. One such device, oXiris, is a hollow-fibre purification filter that clears both endotoxins and cytokines. Due to limited evidence, clinical use of this device is not currently advocated in guidelines. However, clinics do regularly use this device, and there is a critical need for guidance on the application of it in sepsis with and without AKI. Method: A modified Delphi-based method was used to collate-European experts' views on the indication(s), initiation and discontinuation criteria and success measures for oXiris. Results: A panel of 14 participants was selected based on known clinical expertise in the areas of critical care and sepsis management, as well as their experience of using the oXiris blood purification device. The participants used different criteria to initiate treatment with oXiris in sepsis patients with and without AKI. Septic shock with AKI was the priority patient population, with oXiris used to rapidly improve haemodynamic parameters. Achieving haemodynamic stability within 72 h was a key factor for determining treatment success. Conclusion: In the absence of established guidelines, users of hollow-fibre purification devices such as oXiris may benefit from standardised approaches to selecting patients and initiating and terminating treatment, as well as measuring success. Further evidence in the form of randomised clinical trials is urgently required. (c) 2019 The Author(s) Published by S. Karger AG, Basel