期刊
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
卷 36, 期 8, 页码 3015-3020出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.jvca.2022.02.028
关键词
infective endocarditis; cardiac surgery; cytokine adsorber; hemoadsorbtion; systemic inflammatory response syndrome; blood transfusion
This study investigated the impact of using a cytokine hemoadsorber on hemodynamic stability in patients undergoing valve surgery for endocarditis. The results showed that the intervention group had a lower norepinephrine dose and significantly reduced need for red blood cell transfusions postoperatively compared to the control group.
Objectives: Patients with endocarditis requiring urgent valvular surgery with cardiopulmonary bypass are at a high risk of developing systemic inflammatory response syndrome and septic shock, necessitating intensive use of vasopressors after surgery. The use of a cytokine hemoadsorber (CytoSorb, CytoSorbents Europe GmbH, Germany) during cardiac surgery has been suggested to reduce the risk of inflammatory activation. The study authors hypothesized that adding a cytokine adsorber would reduce cytokine burden, which would translate into improved hemodynamic stability. Design: A randomized, controlled, nonblinded clinical trial. Setting: At a university hospital, tertiary referral center. Participants: Nineteen patients with endocarditis undergoing valve surgery. Intervention: A cytokine hemoadsorber integrated into the cardiopulmonary bypass circuit. Measurements and Main Results: The accumulated norepinephrine dose in the intervention group was half or less at all postoperative time points compared to the control group, although it did not reach statistical significance; at 24 and 48 hours (median 36 [25-75 percentiles; 12-57] mu g v 114 [25-559] mu g, p = 0.11 and 36 [12-99] mu g v 261 [25-689] mu g, p = 0.09). There was no significant difference in chest tube output, but there was a significantly lower need for the transfusion of red blood cells (285 [0-657] mL v 1,940 [883-2,148] mL, p = 0.03). Conclusions: There was no statistically significant difference between the groups with regard to vasopressor use after surgery for endocarditis with the use of a cytokine hemoadsorber during cardiopulmonary bypass. Additional, larger randomized controlled trials are needed to definitely assess the potential effect. (C) 2022 Elsevier Inc. All rights reserved.
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