Case report: Early detection of mesenteric ischemia by intravital microscopy in a patient with septic shock

Gut ischemia is a frequent but underdiagnosed complication, especially in critically ill intensive care patients, and represents a special diagnostic challenge that can only be solved in an interdisciplinary manner. We report a case of a 54-year-old woman with acute mesenteric ischemia (AMI) as a cause of septic shock diagnosed by intravital microscopy (IVM) 2 days before visible necrotic changes in a multimodality approach. We show that intravital microscopy can be a serious alternative for the early diagnosis of mesenteric ischemia in the hands of the skilled. We use this case to discuss the value and clinical perspective of IVM in the intensive care setting

Immunomodulation by hemoadsorption

Background: Sepsis is often associated with liver dysfunction, which is an indicator of poor outcomes. Specific diagnostic tools that detect hepatic dysfunction in its early stages are scarce. So far, the immune modulatory effects of hemoadsorption with $CytoSorb^{®}$ on liver function are unclear. Method: We assessed the hepatic function by using the dynamic $LiMAx^{®}$ test and biochemical parameters in 21 patients with sepsis or septic shock receiving $CytoSorb^{®}$ in a prospective, observational study. Points of measurement: T$_1$: diagnosis of sepsis or septic shock; T$_2$ and T$_3$: 24 h and 48 h after the start of $CytoSorb^{®}$; T$_4$: 24 h after termination of $CytoSorb^{®}$. Results: The hepatic biotransformation capacity measured by $LiMAx^{®}$ was severely impaired in up to 95 % of patients. Despite a rapid shock reversal under $CytoSorb^{®}$, a significant improvement in $LiMAx^{®}$ values appeared from T$_3$ to T$_4$. This decline and recovery of liver function were not reflected by common parameters of hepatic metabolism that remained mostly within the normal range. Conclusions: Hepatic dysfunction can effectively and safely be diagnosed with $LiMAx^{®}$ in ventilated ICU patients under $CytoSorb^{®}$. Various static liver parameters are of limited use since they do not adequately reflect hepatic dysfunction and impaired hepatic metabolism