Use of Cytosorb methods in septic conditions in intesive care units

Abstract

Sepsa je po život opasna disfunkcija organa uzrokovana nereguliranim odgovorom domaćina. Umjesto lokalne upale uzrokovane lokalnom infekcijom, što bi bio adekvatan odgovor, cijeli organizam reagira upalom, ozljeđujući vlastita tkiva i organe. Septički šok je najteži oblik sepse koji se očituje padom krvnog tlaka prilikom kojeg se smanjuje tlak perfuzije tkiva što uzrokuje hipoksiju tkiva koja je karakteristična za šok. Najvažniji klinički pokazatelji koji nam potvrđuju dijagnozu septičkog šoka su postojanje potrebe za vazopresorima kako bi se održao srednji arterijski tlak iznad 65 mmHg i/ili više, te porast razine laktata u serumu za 2 mmol/l. Cytosorb je specifično odobren ekstrakorporalni purifikator koji se sastoji od sorbentih zrnaca koji imaju veliku moć adsorpcije upalnih produkata koji nastaju kao rezultat sepse i septičkog šoka. Cytosorb reducira brojne upalne medijatore od kojih valja spomenuti citokine, DAMPs (engl.damage associated molecular patterns), PAMPs (pathogen-associated molecular paterrns- patogeno povezane molekule), kao što su bakterijski endotoksini i egzotoksini, DAMPs (damage associated molecular patterns-molekule povezane sa oštećenjem), kao što su stanični ostaci, mioglobin i plazma slobodni hemoglobin i mnogi drugi kao što su aktivirani komplementi, faktori aktiviranja trombocita i bioaktivni lipidi koji potenciraju upalu. Cytosorb se jednostavno ugrađuje kao dodatni filter u standardni dijalizni aparat. Kompatibilan je sa standardnom pumpom hemoperfuzije u mašini srce-pluća što se koristi za kardiopulmonalni bajpas kod operacije srca ili s pumpom ekstrakorporalne membranske oksigenacije (ECMO) u svrhu održavanja života. Cytosorb je vodeći u kritičkoj medicini imunoterapije, pomaže u kontroli visoke razine upale u životno ugrožavajućim stanjima.Sepsa is the life-threatening organ dysfunction caused by an unregulated response of the host. Instead of the local inflammation caused by local infection, which would be an adequate response, the whole organism reacts with inflammation, injuring its own tissues and organs. Sepsis shock is the toughest form that is manifested by a blood pressure drop, which reduces tissue perfusion pressure causing hypoxia that is characteristic of the shock. The most important clinical evidence that confirms the septic shock diagnosis is the need for vasopressors to maintain a median arterial pressure above 65 mmHg and/or higher and the increase of the serum lactate levels up to 2 mmol/L. Cytosorb is a specifically approved exstracorporeal purifier consisting of sorbent beads which a high adsorption potencial of inflammatory products resulting from sepsa and septic shock. Cytosorb effectively reduces a broad spectrum of other mediators of inflammation ranging from pathogen associated molecular patterns (PAMPs) such as bacterial exotoxins and endotoxins, damage associated molecular patterns (DAMPs) such as cellular debris, myoglobin, and plasma free hemoglobin, and many others such as activated complement, platelet activating factor, and bioactive lipids, that contribute to inflammation. Cytosorb is simply installed as an additional filter in a standard dialysis device. It is compatible with the standard hemoperfusion pump in the heart-lung machine used for cardiopulmonary bypass during open heart operation or with the pump of extracorporeal membrane oxigenation (ECMO) for the purpose of maintaining life. Cytosorb is leading in critical medicine of immunotherapy, helping to control high levels of inflammation in life-threatening conditions