Successful therapy of endotoxin shock
and multiple organ dysfunction using sequential targeted extracorporeal treatment in a patient after combined cardiac surgery
Abstract
Bacterial translocation and severe endotoxemia are some of the causes of infectious complications in patients undergoing cardiopulmonary bypass. Surviving Sepsis Campaign guidelines do not contain clear recommendation on the endotoxemia diagnostics and use of blood purification for endotoxin elimination. Despite this, in clinical practice, a test to determine the level of endotoxin activity (EAA) and new developing laboratory methods to determin blood levels of aromatic microbial metabolites as well as methods of targeted extracorporeal therapy using various membranes are applied more and more often.
The clinical case of treatment of a patient M., who developed endotoxin shock with multiple organ dysfunction (EAA – 1.08 units, lactate – 3.3 mmol/l, norepinephrine up to 430 ng/kg/min, SOFA 10–12 points), after aortocoronary, mamarocoronary bypass surgery and prosthetics of two heart valves against the background of bacterial translocation allows to demonstrate the success of tactics of consistent targeted extracorporeal therapy (2 sessions of PMX-hemoperfusion + 120 hours of оXiris-therapy).
Keywords:microbialload,bacterial translocation,testEAA, aromatic microbial metabolites, endotoxin shock, sepsis, multiple organ dysfunction, PMX hemoperfusion, set oXiris, SETS (Sequential Extracorporeal Therapy in Sepsis)
Conflict of interests. The authors declare no conflict of interests.
For citation: Babaev M.A., Eremenko A.A., Grin O.O., Kostritсa N.S., Dymova O.V., Beloborodova N.V., Pautova A.K., Zakharenkova Yu.S., Levitskya M.V. Successful therapy of endotoxin shock and multiple organ dysfunction using sequential targeted extracorporeal treatment in a patient after combined cardiac surgery. Clin Experiment Surg. Petrovsky J. 2020; 8 (2): 105–14. DOI: 10.33029/2308-1198-2020-8-2-105-114 (in Russian)
Received 05.12.2019. Accepted 26.03.2020.
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