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To explore the relationship between social status perception, professional identity, and work engagement among nurses involved in blood purification, and to provide a theoretical basis for improving the professional identity and work engagement of blood purification nurses. A convenient sampling method was used to distribute questionnaires to 81 nurses specializing in blood purification in Beijing. The MacArthur scale was used to verify the social status perception of the study subjects. General situation questionnaires, nurse professional identity rating scales, and work engagement scales were used to investigate the study subjects. The higher the level of the hospital where the nurse works, the higher their perception of their social status; social status perception has a positive correlation with professional identity among nurses involved in blood purification; social status perception plays a partial mediating role between work engagement and professional identity among nurses involved in blood purification. Attention should be paid to the psychological care of nurses specializing in blood purification, and at the same time, positive publicity should be raised for the profession of nursing specializing in blood purification, to enhance nurses' professional pride and social status perception, thereby improving the professional cognition and work recognition of nurses involved in blood purification, and providing better nursing services for patients. [ABSTRACT FROM AUTHOR]

This study aims to evaluate and predict mortality risks among pediatric patients with hemophagocytic lymphohistiocytosis (HLH). We conducted a retrospective analysis of pediatric patients with HLH diagnosed at the Affiliated Hospital of Zunyi Medical University between January 2012 and April 2023. Patients were divided into a death group and a survival group based on their outcomes. Risk factors for mortality were analyzed using a lasso-logistic regression model. This study included 142 pediatric patients with HLH, with a median age of 40.5 (14.75–84) months, of whom 78 (54.93%) were male. The overall mortality rate was 34.51%. Through lasso-logistic regression analysis, five independent prognostic factors were identified: concurrent central nervous system involvement, multiple organ dysfunction syndrome involving three or more organs, platelet count ≤ 42.5 × 109/L, activated partial thromboplastin time ≥ 54.05 s, and the utilization of blood purification in conjunction with the HLH-94/2004 treatment protocol. The predictive value of the lasso-logistic regression model is better than that of the traditional logistic regression model (AUC: 0.906 vs 0.811, P = 0.001). Subsequently, a lasso-logistic regression-based predictive model incorporating these identified risk factors was developed. Our lasso-logistic regression-based prediction model may help to identify high-risk patients with HLH early, thereby enabling the timely initiation of appropriate treatment interventions. [ABSTRACT FROM AUTHOR]

Background: No specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP), primarily because of the lack of quality evidence. This study aimed to describe practice variations in triglyceride-lowering therapies for early HTG-AP patients and assess whether more rapid triglyceride decline is associated with improving organ failure. Methods: This is a multicentre, prospective cohort study recruiting HTG-AP patients with elevated plasma triglyceride (> 11.3 mmol/L) admitted within 72 h from the onset of symptoms. Patients were dichotomised on study day 3 into either target reaching (plasma triglyceride ≤ 5.65 mmol/L) or not. The primary outcome was organ failure-free days (OFFD) to 14 days of enrolment. The association between target-reaching and OFFD was modelled. Additionally, the slope in plasma triglyceride over the first three days in response to treatment was calculated, and its association with OFFD was assessed as a sensitivity analysis. Results: Among the 300 enrolled patients, 211 underwent exclusive medical treatment, and 89 underwent various blood purification therapies. Triglyceride levels were available in 230 patients on study day 3, among whom 122 (53.0%) had triglyceride levels of ≤ 5.65 mmol/l. The OFFD was not different between these patients and those in whom plasma triglyceride remained > 5.65 mmol/L [median (IQR): 13 (10–14) vs. 14 (10–14), p = 0.46], even after adjustment for potential confounders. For the decline slopes, there was no significant change in OFFD with a steeper decline slope [risk difference, − 0.088, 95% CI, − 0.334 to 0.158, p = 0.48]. Conclusions: Triglyceride-lowering therapies vary greatly across centres. More rapid triglyceride decline was not associated with improving incidence and duration of organ failure. [ABSTRACT FROM AUTHOR]

Introduction: The Seraph® 100 Microbind® Affinity Filter is a biomimetic adsorbent device that can remove pathogens from the blood. Case Presentation: Here, we report the successful use of the Seraph® 100 to treat both a SARS-CoV-2 reinfection leading to severe COVID-19 pneumonia as well as subsequent secondary lung infections including Acinetobacter baumannii, Serratia marcescens, and Pseudomonas aeruginosa multidrug-resistant bacteria. To our knowledge, this 46-year-old black male is the first patient in which four treatments with this pathogen adsorber, one for a viral and three for different bacterial infections, have been successfully used. Conclusion: The Seraph® 100 can be easily and successfully used in conjunction with standard (anti-infective) treatment.

Hongwei Huang,1 Jiacheng Mo,2 Gui Jiang,2 Zheng Lu1 1Intensive Care Unit, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-Sen University, Nanning, Guangxi, 530022, People’s Republic of China; 2Intensive care unit, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People’s Republic of ChinaCorrespondence: Zheng Lu, Intensive Care Unit, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Nanning, Guangxi, 530022, People’s Republic of China, Email iculuzheng@163.comPurpose: To evaluate the long-term efficacy and cost-efficiency of blood purification (BP) in severe acute pancreatitis (SAP) through single-center data.Patients and Methods: A total of 155 SAP patients were collected and followed up for 6 months. The participants were divided into control (49 cases) and BP group (106 cases) according to whether they received BP treatment or not. The primary outcomes were 6-month mortality, length of hospital stay, and hospitalization costs. Propensity score matching (PSM) analysis was performed based on various factors such as gender, age, etiology, SOFA score, JSS score, and creatinine value on day 1.Results: There were significant differences in all baseline data between BP and control groups (p< 0.05). However, there was a significant difference in the mortality, length of hospital stay, hospital costs and infection aggravation rate the in outcome data for 6-months (all p< 0.05). BP was not considered a death factor in any adjusted models, with p-values ranging from 0.81 to 0.93. The results of subgroup analysis after PSM showed that BP mode had no significant impact on prognostic indicators, but the length of ICU stay and total costs were significantly increased (all p< 0.001). There was no significant difference in mortality among the cases that did not require early intervention after 6 months (p=0.487). However, the patients in BP group had longer ICU stays (p=0.001) and higher hospitalization costs (p< 0.001) compared to the control group.Conclusion: The utilization of BP therapy did not decrease the 6-month mortality in SAP patients. Additionally, BP therapy has a significant impact on the duration of ICU stay or hospitalization expenses. However, the effectiveness and cost-efficiency of this therapy are unsatisfactory, and early intervention does not enhance survival benefits. Furthermore, there was no substantial variation in survival benefits between continuous veno-venous hemofiltration (CVVH) alone and compound BP.Keywords: severe acute pancreatitis, blood purification, long-term efficacy, cost-efficiency

Sepsis is responsible for approximately 5.3 million deaths globally each year. Here, we constructed hierarchical chitin microspheres loaded with MOF‐919 (Ch/metal–organic frameworks [MOFs]) for the rapid and efficient removal of lipopolysaccharide (LPS) in complex blood environments. Furthermore, abundant active sites on MOF‐919(Sc) also enable a record‐high adsorption capacity of 9.56 mg/g in biomass‐based adsorbents due to the coordination interactions between endotoxin and MOF‐919(Sc). The LPS level of sepsis rabbits was less than 2 EU/mL (clearance rate >95%) after 90‐min hemoperfusion, showing no adverse effect on the rabbit organs. Additionally, compared to the commonly used LPS scrubber Toraymyxin (polymethyl methacrylate), the chitin adsorbent is significantly more cost‐effective and environmentally friendly. The preparation strategy for hierarchical porous microspheres offers notable advantages in designability, recyclability, and renewability, providing a new approach to sepsis treatment and promising prospects for the biomedical application of sustainable biomass materials. [ABSTRACT FROM AUTHOR]

Extracellular histones are crucial damage-associated molecular patterns involved in the development and progression of multiple critical and inflammatory diseases, such as sepsis, pancreatitis, trauma, acute liver failure, acute respiratory distress syndrome, vasculitis and arthritis. During the past decade, the physiopathologic mechanisms of histone-mediated hyperinflammation, endothelial dysfunction, coagulation activation, neuroimmune injury and organ dysfunction in diseases have been systematically elucidated. Emerging preclinical evidence further shows that anti-histone strategies with either their neutralizers (heparin, heparinoids, nature plasma proteins, small anion molecules and nanomedicines, etc.) or extracorporeal blood purification techniques can significantly alleviate histone-induced deleterious effects, and thus improve the outcomes of histone-related critical and inflammatory animal models. However, a systemic evaluation of the efficacy and safety of these histone-targeting therapeutic strategies is currently lacking. In this review, we first update our latest understanding of the underlying molecular mechanisms of histoneinduced hyperinflammation, endothelial dysfunction, coagulopathy, and organ dysfunction. Then, we summarize the latest advances in histone-targeting therapy strategies with heparin, anti-histone antibodies, histone-binding proteins or molecules, and histone-affinity hemoadsorption in pre-clinical studies. Finally, challenges and future perspectives for improving the clinical translation of histone-targeting therapeutic strategies are also discussed to promote better management of patients with histone-related diseases. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical efficacy and safety of fractionated plasma separation and adsorption combined with continuous veno-venous hemofiltration (FPSA-CVVH) treatment in patients with acute bipyridine herbicide poisoning.Methods A retrospective analysis of 18 patients with acute bipyridine herbicide poisoning was conducted, of which 9 patients were poisoned by diquat and 9 patients by paraquat. All patients underwent FPSA-CVVH treatment. The serum cytokine levels in pesticide-poisoned patients were assessed. The efficacy of FPSA-CVVH in eliminating cytokines, the 90-d survival rate of poisoned patients, and adverse reactions to the treatment were observed.Results Fourteen patients (77.8%) had acute kidney injuries and 10 (55.6%) had acute liver injuries. The serum cytokine levels of high mobility group protein B-1 (HMGB-1), interleukin-6 (IL-6), IL-8, interferon-inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP-1), and macrophage inflammatory protein-1β (MIP-1β) were significantly elevated. A total of 41 FPSA-CVVH treatment sessions were administered. After a single 8-h FPSA-CVVH treatment, the decreases in HMGB-1, IL-6, IL-8, IP-10, MCP-1, and MIP-1β were 66.0%, 63.5%, 73.3%, 63.7%, 53.9%, and 54.1%, respectively. During FPSA-CVVH treatment, one patient required a filter change due to coagulation in the plasma component separator, and one experienced a bleeding adverse reaction. The 90-d patient survival rate was 50%, with 4 patients with diquat poisoning and 5 patients with paraquat poisoning, and both liver and kidney functions were restored to normal.Conclusion Cytokine storms may play a significant role in the progression of multiorgan dysfunction in patients with acute bipyridine herbicide poisoning. FPSA-CVVH can effectively reduce cytokine levels, increase the survival rate of patients with acute bipyridine herbicide poisoning, and decrease the incidence of adverse events.

ObjectiveTo investigate the effects of integrated blood purification on haemodynamics and oxygen metabolism in children with severe sepsis.MethodsClinical data of 12 children with severe sepsis admitted to the pediatric intensive care unit of our hospital between October 2021 and June 2022 were retrospectively analyzed. All patients were treated with integrated blood purification, and changes in haemodynamic parameters, including heart rate, blood pressure, mean arterial pressure and cardiac output, and oxygen metabolism parameters (blood lactic acid, oxygen delivery, oxygen consumption and oxygen extraction rate) were observed before and after treatment.ResultsThe heart rate (134[106,160] vs 111[101,128], p = 0.037), central venous pressure (9[7,10] vs 8[7,9], p = 0.04), stroke output (28[18,43] vs 21[15,31], p = 0.01), blood lactate (3.3[2,4] vs 2.5[1.3,3.6], p = 0.015), oxygen consumption (165.99[121.44,230.31] vs 124.18[82.51,162.86], p = 0.041) and oxygen extraction rate (38.83[31.87,44.62] vs 28.67[21.05,32.72], p = 0.019) were decreased, whereas systolic blood pressure (97[83,104] vs 107[94,116], p = 0.033) and central venous oxygen pressure (32[29, 37] vs 39[34,46], p = 0.005) were increased in the children after treatment compared with before treatment. There were no statistically significant differences in diastolic blood pressure, mean arterial pressure, cardiac output, arterial oxygen pressure and oxygen delivery before and after treatment (all p > 0.05).ConclusionIntegrated blood purification can improve haemodynamic and oxygen metabolism parameters in children with severe sepsis, with a high value in clinical application.

Abstract Background Rhabdomyolysis describes a syndrome characterized by muscle necrosis and the subsequent release of creatine kinase and myoglobin into the circulation. Myoglobin elimination with extracorporeal hemoadsorption has been shown to effectively remove myoglobin from the circulation. Our aim was to provide best practice consensus statements developed by the Hemoadsorption in Rhabdomyolysis Task Force (HRTF) regarding the use of hemadsorption for myoglobin elimination. Methods A systematic literature search was performed until 11th of January 2023, after which the Rhabdomyolysis RTF was assembled comprising international experts from 6 European countries. Online conferences were held between 18th April − 4th September 2023, during which 37 consensus questions were formulated and using the Delphi process, HRTF members voted online on an anonymised platform. In cases of 75 to 90% agreement a second round of voting was performed. Results Using the Delphi process on the 37 questions, strong consensus (> 90% agreement) was achieved in 12, consensus (75 to 90% agreement) in 10, majority (50 to 74%) agreement in 13 and no consensus ( 10,000 ng/ml should be considered for extracorporeal myoglobin removal by hemoadsorption; (3) Hemoadsorption should ideally be started within 24 h of admission; (4) If myoglobin cannot be measured then hemoadsorption may be indicated based on clinical picture and creatinine kinase levels; (5) Cartridges should be replaced every 8–12 h until myoglobin levels

Abstract The evidence supporting additional hemoperfusion (HP) with cytokine adsorbents for improving clinical outcomes in severe to critical coronavirus disease 2019 (COVID-19) patients remains limited. We compared severe to critical COVID-19 patients who received additional HP with a cytokine adsorbent to matched cases receiving standard medical treatment (SMT). The primary outcome was hospital mortality. In our study, we matched 45 patients who received additional HP 1:1 with the SMT group based on key clinical parameters. The hospital mortality rates did not differ between the groups (33% vs 38%, p = 0.83). The HP group had a significantly shorter ICU stay (22 vs 32 days; p = 0.017) and reduced mechanical ventilation duration (15 vs 35 days; p

Abstract Background Extracorporeal blood purification has been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic review aimed to critically assess the role of perioperative hemoadsorption in cardiac surgery, by summarizing the current knowledge in this clinical setting. Methods A literature search of PubMed, Cochrane library, and the database provided by CytoSorbents was conducted on June 1st, 2023. The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search, including language variations of terms “cardiac surgery” and “hemoadsorption”. The screening and selection process followed scientific principles (PRISMA statement). Abstracts were considered for inclusion if they were written in English and published within the last ten years. Publications were eligible for assessment if reporting on original data from any type of study (excluding case reports) in which a hemoadsorption device was investigated during or after cardiac surgery. Results were summarized according to sub-fields and presented in a tabular view. Results The search resulted in 29 publications with a total of 1,057 patients who were treated with hemoadsorption and 988 control patients. Articles were grouped and descriptively analyzed due to the remarkable variability in study designs, however, all reported exclusively on CytoSorb® therapy. A total of 62% (18/29) of the included articles reported on safety and no unanticipated adverse events have been observed. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability. Conclusions The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery in patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Future large randomized controlled trials are needed to better define proper patient selection, dosing, and timing of the therapy.

Background: Rhabdomyolysis describes a syndrome characterized by muscle necrosis and the subsequent release of creatine kinase and myoglobin into the circulation. Myoglobin elimination with extracorporeal hemoadsorption has been shown to effectively remove myoglobin from the circulation. Our aim was to provide best practice consensus statements developed by the Hemoadsorption in Rhabdomyolysis Task Force (HRTF) regarding the use of hemadsorption for myoglobin elimination. Methods: A systematic literature search was performed until 11th of January 2023, after which the Rhabdomyolysis RTF was assembled comprising international experts from 6 European countries. Online conferences were held between 18th April − 4th September 2023, during which 37 consensus questions were formulated and using the Delphi process, HRTF members voted online on an anonymised platform. In cases of 75 to 90% agreement a second round of voting was performed. Results: Using the Delphi process on the 37 questions, strong consensus (> 90% agreement) was achieved in 12, consensus (75 to 90% agreement) in 10, majority (50 to 74%) agreement in 13 and no consensus (< 50% agreement) in 2 cases. The HRTF formulated the following recommendations: (1) Myoglobin contributes to the development of acute kidney injury; (2) Patients with myoglobin levels of > 10,000 ng/ml should be considered for extracorporeal myoglobin removal by hemoadsorption; (3) Hemoadsorption should ideally be started within 24 h of admission; (4) If myoglobin cannot be measured then hemoadsorption may be indicated based on clinical picture and creatinine kinase levels; (5) Cartridges should be replaced every 8–12 h until myoglobin levels < 10,000 ng/ml; (6) In patients with acute kidney injury, hemoadsorption can be discontinued before dialysis is terminated and should be maintained until the myoglobin concentration values are consistently < 5000 ng/ml. Conclusions: The current consensus of the HRTF support that adjuvant hemoadsorption therapy in severe rhabdomyolysis is both feasible and safe and may be an effective method to reduce elevated circulating levels of myoglobin. [ABSTRACT FROM AUTHOR]

The evidence supporting additional hemoperfusion (HP) with cytokine adsorbents for improving clinical outcomes in severe to critical coronavirus disease 2019 (COVID-19) patients remains limited. We compared severe to critical COVID-19 patients who received additional HP with a cytokine adsorbent to matched cases receiving standard medical treatment (SMT). The primary outcome was hospital mortality. In our study, we matched 45 patients who received additional HP 1:1 with the SMT group based on key clinical parameters. The hospital mortality rates did not differ between the groups (33% vs 38%, p = 0.83). The HP group had a significantly shorter ICU stay (22 vs 32 days; p = 0.017) and reduced mechanical ventilation duration (15 vs 35 days; p < 0.001). Additionally, the incidence of pulmonary complications (20% vs 42%; p = 0.04), sepsis (38% vs 64%; p = 0.02), and disseminated intravascular coagulopathy (DIC) (13% vs 33%; p = 0.046) were significantly lower in the HP group. In conclusion, among severe to critical COVID-19 patients, additional HP with a cytokine adsorbent did not improve hospital mortality. However, it reduced ICU length of stay, mechanical ventilator days, and incidences of lung complications, sepsis, and DIC. Trial registration: TCTR20231002006. Registered 02 October 2023 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: Extracorporeal blood purification has been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic review aimed to critically assess the role of perioperative hemoadsorption in cardiac surgery, by summarizing the current knowledge in this clinical setting. Methods: A literature search of PubMed, Cochrane library, and the database provided by CytoSorbents was conducted on June 1st, 2023. The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search, including language variations of terms "cardiac surgery" and "hemoadsorption". The screening and selection process followed scientific principles (PRISMA statement). Abstracts were considered for inclusion if they were written in English and published within the last ten years. Publications were eligible for assessment if reporting on original data from any type of study (excluding case reports) in which a hemoadsorption device was investigated during or after cardiac surgery. Results were summarized according to sub-fields and presented in a tabular view. Results: The search resulted in 29 publications with a total of 1,057 patients who were treated with hemoadsorption and 988 control patients. Articles were grouped and descriptively analyzed due to the remarkable variability in study designs, however, all reported exclusively on CytoSorb® therapy. A total of 62% (18/29) of the included articles reported on safety and no unanticipated adverse events have been observed. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability. Conclusions: The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery in patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Future large randomized controlled trials are needed to better define proper patient selection, dosing, and timing of the therapy. [ABSTRACT FROM AUTHOR]

Abstract Sepsis is responsible for approximately 5.3 million deaths globally each year. Here, we constructed hierarchical chitin microspheres loaded with MOF‐919 (Ch/metal–organic frameworks [MOFs]) for the rapid and efficient removal of lipopolysaccharide (LPS) in complex blood environments. Furthermore, abundant active sites on MOF‐919(Sc) also enable a record‐high adsorption capacity of 9.56 mg/g in biomass‐based adsorbents due to the coordination interactions between endotoxin and MOF‐919(Sc). The LPS level of sepsis rabbits was less than 2 EU/mL (clearance rate >95%) after 90‐min hemoperfusion, showing no adverse effect on the rabbit organs. Additionally, compared to the commonly used LPS scrubber Toraymyxin (polymethyl methacrylate), the chitin adsorbent is significantly more cost‐effective and environmentally friendly. The preparation strategy for hierarchical porous microspheres offers notable advantages in designability, recyclability, and renewability, providing a new approach to sepsis treatment and promising prospects for the biomedical application of sustainable biomass materials.

Abstract Background In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies. Methods A panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method. Results The consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions. Conclusions Although clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice.

Background: In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies. Methods: A panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method. Results: The consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions. Conclusions: Although clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice. [ABSTRACT FROM AUTHOR]

Sepsis is the leading cause of patient admission to the intensive care unit (ICU). Most of the sepsis patients experience multi-organ failure, such as respiratory and kidney failure, that require specific support. Continuous renal replacement therapy (CRRT) is one of the modalities performed in the ICU to help ameliorate cytokine levels, maintain fluid balance, and remove toxins. CRRT allows early ventilator weaning, a reduction in vasopressor or inotropic administration, and early discharge from the ICU. We report an experience of initiating an early CRRT in a patient with septic shock and acute kidney injury with fluid overload. During CRRT, the patient showed significant improvement in ventilation, hemodynamic, and fluid balance. However, the CRRT had to be discontinued due to limited resources and the infection rebounded. The patient in this case study died on the 14th day following admission. Early CRRT may be an effective therapy in septic shock patients; however, it requires continuous application that may not be possible in low-resource setting. Alternatively, sustained low-efficiency daily dialysis (SLEDD) has no major disadvantages compared to CRRT and may be a feasible option [ABSTRACT FROM AUTHOR]

This manuscript investigates the role of extracorporeal blood purification techniques in managing septic hyperinflammation, a critical aspect of sepsis characterized by an uncontrolled immune response leading to multiorgan dysfunction. We provide an overview of sepsis, focusing on the dynamics of immune response, the involvement of neutrophils, and the role of the endothelium in the disease's progression. It evaluates the effectiveness of various blood purification methods, including high-cut-off membranes, high-volume hemofiltration, adsorption techniques, and albumin dialysis, in removing cytokines and endotoxin and improving hemodynamic stability. Despite some very promising results, we conclude that the current evidence does not strongly support these techniques in significantly improving survival rates in septic patients, clearly underlining the need for further research. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of continuous blood purification in conjunction with reduced glutathione on endotoxin levels, inflammatory mediators and the severity of liver injury in septic shock patients. Methods: A cohort of 100 septic shock patients admitted at The Second Affiliated Hospital of Hainan Medical University, China between May 2020 and May 2023 were enrolled in this study. They were randomly divided into study and control groups, each comprising 50 patients. Both groups received standard interventions. In addition, control group underwent continuous blood purification, while study group received reduced glutathione therapy for two weeks. Acute physiology score + age point + chronic health point (APACHE II) and sequential organ failure assessment (SOFA) scores, intensive care unit (ICU) and mechanical ventilation duration, oxygenation levels, 28-day mortality, organ injury, serum endotoxin levels, inflammatory markers, as well as serum aspartate aminotransferase (AST) and glutamate aminotransferase (ALT) levels were determined before and after treatment. Adverse events during treatment were documented. Results: Both groups exhibited a significant decrease in APACHE II and SOFA scores, with greater decreases observed in study group (p < 0.05). The study group had shorter ICU stays and mechanical ventilation durations. The groups had no significant differences in 28-day mortality or organ injury (p > 0.05). Study group demonstrated significantly lower levels of endotoxin, tumor necrosis factor (TNF-a), procalcitoninogen (PCT), ALT and AST in comparison to control group (p < 0.05). Adverse reactions were similar between the two groups (p > 0.05). Conclusion: Combining continuous blood purification with reduced glutathione therapy reduces endotoxin and inflammatory mediator levels, mitigates liver injury and supports patient recovery in septic shock, with a favorable safety profile. Future studies to accommodate the diverse profiles of septic shock patients from multiple centers will be needed to validate the outcomes of this study. [ABSTRACT FROM AUTHOR]

The purpose of blood purification therapy is to remove uremic toxins, and middle molecules (MMs) are a specific target. An MM is defined as a solute that passes through the glomerulus with a molecular weight in the range of 0.5–58 kDa, and new classifications of "small-middle 0.5–15 kDa," "medium-middle 15–25 kDa," and "large-middle 25–58 kDa" were proposed. In Japan, the removal of α1-microglobulin (αMG) in the large-middle range has been the focus, but a new theory of removal has been developed, emphasizing the antioxidant effect of αMG as a physiological function. Clinical proof of this mechanism will lead to further development of blood purification therapies. [ABSTRACT FROM AUTHOR]

Sepsis and septic shock are associated with high mortality, with diagnosis and treatment remaining a challenge for clinicians. Their management classically encompasses hemodynamic resuscitation, antibiotic treatment, life support, and focus control; however, there are aspects that have changed. This narrative review highlights current and avant-garde methods of handling patients experiencing septic shock based on the experience of its authors and the best available evidence in a context of uncertainty. Following the first recommendation of the Surviving Sepsis Campaign guidelines, it is recommended that specific sepsis care performance improvement programs are implemented in hospitals, i.e., "Sepsis Code" programs, designed ad hoc, to achieve this goal. Regarding hemodynamics, the importance of perfusion and hemodynamic coherence stand out, which allow for the recognition of different phenotypes, determination of the ideal time for commencing vasopressor treatment, and the appropriate fluid therapy dosage. At present, this is not only important for the initial timing, but also for de-resuscitation, which involves the early weaning of support therapies, directed elimination of fluids, and fluid tolerance concept. Finally, regarding blood purification therapies, those aimed at eliminating endotoxins and cytokines are attractive in the early management of patients in septic shock. [ABSTRACT FROM AUTHOR]

Abstract Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is characterized by a violent cytokine storm-driven inflammation and is associated with a predisposition to severe disease. The treatment strategy for HTG-AP consists mainly of conventional symptomatic and lipid-lowering treatments. For early-stage HTG-AP, blood purification (BP) can rapidly and effectively reduce serum triglyceride and inflammatory cytokine levels, block the development of systemic inflammatory response syndrome, and improve patient outcomes. Currently, the primary modalities for BP in patients with HTG-AP include plasma exchange, hemoperfusion, and hemofiltration. When using BP to treat patients with HTG-AP, a comprehensive analysis incorporating the elevated lipid levels and severity of the patient’s condition contributes to the selection of different treatment modes. Moreover, the timing of the treatment is also imperative. Early intervention is associated with a better prognosis for patients with HTG-AP requiring lipid-lowering treatment.

We aimed to investigate the clinical efficacy of blood purification technology based on cytokine adsorption in the treatment of sepsis. Sixty patients with sepsis were randomly divided into control (n = 30) and experimental (n = 30) groups. Both groups were given routine treatment and continuous venovenous hemofiltration, and on this basis, the experimental group received acrylonitrile/sodium methacrylate (AN69ST) blood purification. The levels of C-reactive protein, procalcitonin, white blood cell count, albumin, platelets, total bilirubin, creatinine, lactic acid, and APACE II score, as well as secretion of inflammatory factors interleukin (IL)-6 and tumor necrosis factor (TNF-α) were compared. The hospitalization time, mechanical ventilation (MV) time, drug use time, and mortality were analyzed. After treatment, the secretion levels of IL-6 and TNF-α were decreased, and other indicators were significantly improved compared with those before treatment (P < 0.05), especially in the experimental group (P < 0.05). The hospitalization time, MV time, and drug use time in the experimental group were significantly lower than those of the control group (P < 0.05), and the mortality was lower than that in the control group (P < 0.05). In conclusion, blood purification technology based on cytokine adsorption can significantly improve various indicators of sepsis patients, reduce hospitalization time, reduce mortality, and improve the prognosis.

Background/aim: Extracorporeal blood purification (EBP) therapies have shown promise as potential rescue treatments for patients with septic shock. However, precise evidence regarding their effectiveness is lacking. This case-control study aimed to evaluate the 28-day survival benefit of a resin cartridge-based EBP therapy compared to conventional therapies in patients with septic shock. Materials and methods: The study sample was collected retrospectively from the medical records of patients admitted to the intensive care unit (ICU) between 2015 and 2020. The study included patients with septic shock aged =18 years who had ICU stays >96 h and excluded those lost to follow-up by 28 days or readmitted. First, 28-day survival was compared between EBP patients and 1:1 matched conventionally treated controls. Second, the EBP patients were evaluated for clinical and laboratory improvements within 72 h of EBP therapy. Results: Of 3742 patients, 391 were included in this study, of whom 129 received EBP therapy and had a 28-day survival rate of 44%, compared to 262 matched controls who received conventional therapy alone and had a survival rate of 33% (p = 0.001, log-rank = 0.05, number needed to treat = 8, and odds ratio = 1.7). After receiving EBP therapy for 72 h, improvements were observed in the Sequential Organ Failure Assessment scores (p < 0.05), shock indices (p < 0.05), partial pressure of oxygen in the arterial blood to the fraction of inspiratory oxygen concentration ratios (p < 0.001), vasopressor requirements (p < 0.001), pH (p < 0.05), lactate levels (p < 0.001), and C-reactive protein levels (p < 0.05). Conclusion: The findings suggest that administering resin cartridge-based EBP therapy to patients with septic shock may improve their survival compared to conventional therapies. [ABSTRACT FROM AUTHOR]

Severe rhabdomyolysis frequently results in acute kidney injury (AKI) due to myoglobin accumulation with the need of kidney replacement therapy (KRT). The present study investigated whether the application of Cytosorb® (CS) led to an increased rate of kidney recovery in patients with KRT due to severe rhabdomyolysis. Adult patients with a myoglobin-concentration >10,000 ng/ml and KRT were included from 2014 to 2021. Exclusion criteria were chronic kidney disease and CS-treatment before study inclusion. Groups 1 and 2 were defined as KRT with and without CS, respectively. The primary outcome parameter was independence from KRT after 30 days. Propensity score (PS) matching was performed (predictors: myoglobin, SAPS-II, and age), and the chI²-test was used. 35 pairings could be matched (mean age: 57 vs. 56 years; mean myoglobin: 27,218 vs. 26,872 ng/ml; mean SAPS-II: 77 vs. 76). The probability of kidney recovery was significantly (p = .04) higher in group 1 (31.4 vs. 11.4%, mean difference: 20.0%, odds ratio (OR): 3.6). Considering patients who survived 30 days, kidney recovery was also significantly (p = .03) higher in patients treated with CS (61.1 vs. 23.5%, mean difference: 37.6%, OR: 5.1). In conclusion, the use of CS might positively affect renal recovery in patients with severe rhabdomyolysis. A prospective randomized controlled trial is needed to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is characterized by a violent cytokine storm-driven inflammation and is associated with a predisposition to severe disease. The treatment strategy for HTG-AP consists mainly of conventional symptomatic and lipid-lowering treatments. For early-stage HTG-AP, blood purification (BP) can rapidly and effectively reduce serum triglyceride and inflammatory cytokine levels, block the development of systemic inflammatory response syndrome, and improve patient outcomes. Currently, the primary modalities for BP in patients with HTG-AP include plasma exchange, hemoperfusion, and hemofiltration. When using BP to treat patients with HTG-AP, a comprehensive analysis incorporating the elevated lipid levels and severity of the patient's condition contributes to the selection of different treatment modes. Moreover, the timing of the treatment is also imperative. Early intervention is associated with a better prognosis for patients with HTG-AP requiring lipid-lowering treatment. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) is often a consequence of a dysregulated immune response; therefore, immunomodulation by extracorporeal cytokine removal has been increasingly used as an adjuvant therapy, but convincing data are still missing. The aim of this study was to investigate the effects of adjunctive hemoadsorption (HA) on clinical and laboratory outcomes in patients with ARDS. Methods: We performed a systematic literature search in PubMed, Embase, CENTRAL, Scopus, and Web of Science (PROSPERO: CRD42022292176). The population was patients receiving HA therapy for ARDS. The primary outcome was the change in PaO2/FiO2 before and after HA therapy. Secondary outcomes included the before and after values for C-reactive protein (CRP), lactate, interleukin-6 (IL-6), and norepinephrine (NE) doses. Results: We included 26 publications, with 243 patients (198 undergoing HA therapy and 45 controls). There was a significant improvement in PaO2/FiO2 ratio following HA therapy (MD = 68.93 [95%-CI: 28.79 to 109.06] mmHg, p = 0.005) and a reduction in CRP levels (MD = −45.02 [95%-CI: −82.64; −7.39] mg/dL, p = 0.026) and NE dose (MD = −0.24 [95%-CI: −0.44 to −0.04] μg/kg/min, p = 0.028). Conclusions: Based on our findings, HA resulted in a significant improvement in oxygenation and a reduction in NE dose and CRP levels in patients treated with ARDS. Properly designed RCTs are still needed. [ABSTRACT FROM AUTHOR]

Background: Therapeutic plasma exchange (TPE) can be technically challenging in critically ill children in pediatric intensive care unit (PICU). This study was done to characterize the indications, technical aspects, safety, and outcomes of TPE in critically ill children admitted to PICU. Subjects and Methods: This was a retrospective study by analyzing the electronic medical records of 33 critically ill children (1 month–18 years of age) who underwent TPE in PICU. Results: A total of 33 patients underwent 122 TPE sessions. The most common diagnosis for TPE was acute liver failure (48.48%). Invasive mechanical ventilator (MV) and renal replacement therapy (RRT-continuous RRT [CRRT]/intermittent hemodialysis) were needed in 72.7%. Vasoactive support was needed in 63.6%, of whom 76% needed ≥2 vasoactive medications. Organ dysfunction of ≥3 organs was seen in 66.6%. One patient was also on extracorporeal membrane oxygenation (ECMO) support. Survival to intensive care unit discharge was 59.3%. Mortality was highest for liver failure (9/16: 56%), followed by sepsis with multiple organ dysfunction syndrome (40%). TPE without needing dialysis had a survival rate of 75%, while TPE with CRRT had a survival rate of 45%. Survival with ≥3 organ dysfunction was 36.3%. Factors associated with increased mortality were MV (P = 0.0115), need for vasoactive medications (P = 0.0002), organ dysfunction (P = 0.005), and specific indications (P = 0.0458). Complications were noted in 2.4%. Conclusions: TPE can be performed safely in critically ill children in combination with RRT and ECMO. The need for MV, multiple vasoactive medications, liver failure, sepsis, and higher number of organ failures were significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of the study is to investigate whether the multistage draining cannula strategy inserted via the femoral vein and with blood return to the jugular vein can improve the therapeutic efficiency in patients with vena cava drainage disorder compared to traditional hemodialysis therapy. Design This study was approved by the Review Board of the Ethics Committee of Zhongshan Hospital, Fudan University (No. B2022-380), and the need for obtaining signed informed consent was waived for this retrospective analysis. Patients Two adult patients with acute vena cava reflux disorder were analyzed retrospectively in the study. Interventions To minimize recirculation, a multistage draining cannula strategy in a suitable position inserted via the femoral vein and with blood return to the jugular vein was used in patients with vena cava obstruction. Measurements and Main Results Study endpoints included vasopressors equivalent dose, ICU outcome and other clinical outcomes. The results showed that blood purification based on dual-cannula in jugular-femoral venous was able to improve the hemodynamic state, reduce the vasopressors dosage and improve the outcome for critically ill patients with acute vena cava reflux disorder. Conclusions Blood purification therapy with dual-cannula in jugular-femoral venous may be an effective and feasible strategy for patients with acute superior or inferior vena cava “obstruction”.

Background Calcium channel blockers (CCBs) are the most commonly used class of antihypertensive drugs in China. Despite the high mortality rate of severe CCBs poisoning, few relevant reports on its clinical characteristics can be found currently. Objective To analyze the clinical characteristics of acute CCBs poisoning and the value of blood purification therapy by summarizing the clinical manifestations and treatment results of 11 patients with acute CCBs poisoning. Methods A retrospective analysis was conducted with regard to the clinical presentation, scores for condition assessment, treatment process and prognosis of 11 patients who presented to the Emergency Department, Peking University Third Hospital for acute CCBs poisoning from January 2019 to June 2022. Results Of the 11 patients, 3 were female and 8 were male. The average age was (39.8±18.0) years and the median interval between drug administration and consultation was 2.25 (6.58) hours. The main clinical manifestations at presentation were shock (9 cases, 9/11) , nausea and vomiting (5 cases, 5/11) , dizziness (4 cases, 4/11) , fatigue (3 cases, 3/11) , tachycardia (3 cases, 3/11) , bradycardia (2 cases, 2/11) , syncope (1 case, 1/11) and lethargy (1 case, 1/11) . Ten patients arrived at the ED with a clear consciousness (with a Glasgow Coma Score of 15 points) . In addition to conventional treatment, 6 of the patients received blood purification treatment, including hemoperfusion, plasma exchange and continuous veno-venous hemofiltration (CVVH) in 2 cases, hemoperfusion combined with CVVH in 2 cases, and hemoperfusion alone in 2 cases. Four of these 6 patients also received extracorporeal membrane pulmonary oxygenation therapy. The blood concentration of CCBs decreased after the first blood purification treatment, and the percentage of decrease was higher for nifedipine (40.00%-63.64%) than for amlodipine and verapamil (9.09%-26.67%) . Nine of the 11 patients survived at discharge. The median Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score at admission was 10 (25) points. The median Poisoning Severity Score (PSS) at admission was 3 (1) points. Two of the 8 patients with a PSS score of 3 points at admission died, and two of the 5 patients with an APACHEⅡ score ≥15 points at admission died. Conclusion Clarity of consciousness at the early stage of shock is a more common manifestation of acute CCBs poisoning. Hemoperfusion may play a more effective role in acute nifedipine poisoning than in acute amlodipine and verapamil poisoning. The APACHEⅡ score may be superior to the PSS score in predicting the prognosis of death in acute poisoning of CCBs.

ObjectiveTo analyze the clinical features， treatment and prognosis of patients with respiratory depression caused by glufosinate poisoning.MethodsThe clinical data of patients with respiratory depression caused by glufosinate poisoning admitted to the ICU of Xiangshan first people’s hospital medical and health group from March 2018 to January 2022 were retrospectively analyzed.ResultsA total of 21 patients with respiratory depression caused by glufosinate poisoning were included. The median （interquartile） intake of glufosinate was 30 （20， 40） g， and the median （interquartile） visit time was within 2.0 （1.0， 2.8） h. The initial symptoms were nausea and vomiting in 16 cases （76.2%）， and sore throat in 8 cases （38.1%）. Respiratory depression， convulsions and shock occurred 6‒48 hours after ingestion of glufosinate. Convulsion occurred in 13 cases （61.9%）， shock in 10 cases （47.6%） and bradycardia in 5 cases （23.8 %）. Among the patients with convulsion or shock， respiratory depression occurred earlier than convulsion and shock in 10 cases （76.9%） and 9 cases （90.0%）， respectively. All patients were treated with gastric lavage， catharsis， mechanical ventilation and symptomatic support. Blood purification was performed in 14 cases. The duration of mechanical ventilation was 5.0 （4.0， 7.0） d，and no patient died. The patients were divided into blood purification group and routine treatment group. There was no significant difference in complications and duration of mechanical ventilation between the blood purification group and the routine treatment group （P>0.05）.ConclusionRespiratory depression caused by glufosinate poisoning usually occurs earlier than convulsion and shock. The overall prognosis of patients with respiratory depression caused by glufosinate poisoning is good， which mainly depends on the early recognition and intervention of respiratory depression.

IntroductionTrauma-related severe bleeding and peripartum hemorrhage complicated by shock state is challenging for acute care physicians. Management steps relating to each other include damage control surgery, maintenance of optimal clotting preconditions, point-of-care and targeted supplementation of coagulation factors, control of hyperfibrinolysis, and supplementation of thrombocytes. Extensive tissue damage and surgical management of bleeding activate the proinflammatory process, leading to a dysregulated immune response. The originating systemic inflammation produces further damage, harmfully altering clot formation through the activation of immunothrombosis.Clinical findingsThe case report presents one obstetric, massive bleeding patient and one politraumatized patient with severe hemorrhage. Both underwent extended surgery regarding bleeding control intervention.Interventions and outcomeElimination of coagulation disorder was driven by point-of-care viscoelastometry and targeted clotting factor supplementation. Continuous renal replacement therapy and the hemadsorption technique augmented the well-established, up-to-date recommendations-guided care throughout the treatment line. The patients could leave the intensive care unit 4 and 8 days following the initial injury.ConclusionPrompt administration of extracorporeal organ support enhanced the recovery from hemorrhagic shock.

Sepsis represents one of the major health problem due to the high mortality rate and elevated health care costs. An important role in the genesis and the mechanisms sustaining sepsis has been found in the release of pro-inflammatory mediators. They are able to induce hemodynamic instability, end-organ dysfunction, and coagulation abnormalities. The host immune response involves a first extreme response to infective process that leads to tissue damage, organ failure and endothelial dysfunction. It was recently described the existence of a contrasting process, that is directed to restore homeostasis and it's related with the release of anti-inflammatory mediators. The treatment of sepsis and septic shock could therefore benefit from the association of source control and antibiotic therapy with the use of drugs and other techniques, that act by modulating the cytokine storm. This approach is referred to an adjuvant therapy. The goal of this narrative review is to examine the various adjuvant therapies in the treatment of sepsis and septic shock. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to investigate whether the multistage draining cannula strategy inserted via the femoral vein and with blood return to the jugular vein can improve the therapeutic efficiency in patients with vena cava drainage disorder compared to traditional hemodialysis therapy. Design: This study was approved by the Review Board of the Ethics Committee of Zhongshan Hospital, Fudan University (No. B2022-380), and the need for obtaining signed informed consent was waived for this retrospective analysis. Patients: Two adult patients with acute vena cava reflux disorder were analyzed retrospectively in the study. Interventions: To minimize recirculation, a multistage draining cannula strategy in a suitable position inserted via the femoral vein and with blood return to the jugular vein was used in patients with vena cava obstruction. Measurements and Main Results: Study endpoints included vasopressors equivalent dose, ICU outcome and other clinical outcomes. The results showed that blood purification based on dual-cannula in jugular-femoral venous was able to improve the hemodynamic state, reduce the vasopressors dosage and improve the outcome for critically ill patients with acute vena cava reflux disorder. Conclusions: Blood purification therapy with dual-cannula in jugular-femoral venous may be an effective and feasible strategy for patients with acute superior or inferior vena cava "obstruction". [ABSTRACT FROM AUTHOR]

Abstract Background Miliary tuberculosis is a life-threatening disease caused by the hematogenous spread of Mycobacterium tuberculosis. It is uncommon in pregnancy. Mortality rates for patients with miliary tuberculosis who require mechanical ventilation are high (60–70%). Case presentation We reported a rare and challenging case, a 35-year-old Asian woman with 34 weeks of pregnancy, and miliary tuberculosis with acute respiratory distress syndrome and septic shock. The patient presented with severe acute respiratory distress syndrome, necessitating mechanical ventilation, vasopressor, and pregnancy termination with caesarean section. The patient underwent blood purification with continuous veno-venous hemofiltration using an oXiris filter for 24 hours. After continuous veno-venous hemofiltration, the patient’s condition was greatly improved, and the patient was successfully extubated and was able to breathe spontaneously without vasopressor on the third day. High levels of interleukin-6, interleukin-10, procalcitonin, C-reactive protein, interferon-γ, and tumor necrosis factor-α were found postoperatively. Conclusion The bacterial infection of tuberculosis, acute respiratory distress syndrome, and the stress response from the caesarean section contributed to the high levels of cytokines, which correlated with the patient’s severe inflammatory condition. The cytokine levels were greatly reduced after the blood purification procedure and this might be associated with the patient’s clinical improvement. Extracorporeal blood purification could help to disrupt the vicious cycle of inflammation.

Xingyi Wang, Lishuang Bai, Xiao Ma, Li-Shan Yang Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750000, People’s Republic of ChinaCorrespondence: Li-Shan Yang, Email nyfyyls@126.comAbstract: Arsenic and its compounds are widely found in nature. They are often absorbed into the human body through the respiratory tract, skin and digestive tract, and distributed throughout the body through the blood. It is more common in coal burning arsenic poisoning and drinking water arsenic poisoning. In recent years, arsenic poisoning related to industrial production has also been reported. Two cases of hydrogen arsenide poisoning related to industrial production were reported and analyzed in order to improve the treatment level.Keywords: hydrogen arsenide poisoning, blood purification, special effect antidote, cluster therapy

Abstract Background This study investigated the efficacy of the integrated blood purification mode of early haemoperfusion (HP) combined with continuous venovenous haemodiafiltration (CVVHDF) in children with severe viral encephalitis, and evaluated the correlation of cerebrospinal fluid (CSF) neopterin (NPT) levels with prognosis. Methods The records of children with viral encephalitis who received blood purification treatment in the authors’ hospital from September 2019 to February 2022 were retrospectively analysed. According to the blood purification treatment mode, they were divided into the experimental group (HP + CVVHDF, 18 cases), control group A (CVVHDF only, 14 cases), and control group B (16 children with mild viral encephalitis who did not receive blood purification treatment). The correlation between the clinical features, severity of the disease and the extent of lesions on brain magnetic resonance imaging (MRI) and the CSF NPT levels was analysed. Results The experimental group and control group A were comparable with respect to age, gender and hospital course (P > 0.05). There was no significant difference in speech and swallowing functions between the two groups after treatment (P > 0.05) and no significant difference in 7 and 14-day mortality (P > 0.05). The CSF NPT levels in the experimental group before treatment were significantly higher compared with control group B (P

Background: Therapeutic plasma exchange (TPE) can be technically challenging in critically ill children in pediatric intensive care unit (PICU). This study was done to characterize the indications, technical aspects, safety, and outcomes of TPE in critically ill children admitted to PICU. Subjects and Methods: This was a retrospective study by analyzing the electronic medical records of 33 critically ill children (1 month–18 years of age) who underwent TPE in PICU. Results: A total of 33 patients underwent 122 TPE sessions. The most common diagnosis for TPE was acute liver failure (48.48%). Invasive mechanical ventilator (MV) and renal replacement therapy (RRT-continuous RRT [CRRT]/intermittent hemodialysis) were needed in 72.7%. Vasoactive support was needed in 63.6%, of whom 76% needed ≥2 vasoactive medications. Organ dysfunction of ≥3 organs was seen in 66.6%. One patient was also on extracorporeal membrane oxygenation (ECMO) support. Survival to intensive care unit discharge was 59.3%. Mortality was highest for liver failure (9/16: 56%), followed by sepsis with multiple organ dysfunction syndrome (40%). TPE without needing dialysis had a survival rate of 75%, while TPE with CRRT had a survival rate of 45%. Survival with ≥3 organ dysfunction was 36.3%. Factors associated with increased mortality were MV (P = 0.0115), need for vasoactive medications (P = 0.0002), organ dysfunction (P = 0.005), and specific indications (P = 0.0458). Complications were noted in 2.4%. Conclusions: TPE can be performed safely in critically ill children in combination with RRT and ECMO. The need for MV, multiple vasoactive medications, liver failure, sepsis, and higher number of organ failures were significantly associated with mortality.

Adsorption or enrichment has been an indispensable and important measure in biomedical engineering since it is promising in diagnosis and treatment of complex diseases. The ongoing development in this arena starves for exploration of outstanding adsorptive materials. As an excellent candidate for adsorption or enrichment carriers, carbon-based material has demonstrated unique superiority in biomedical arena owing to its integrated characteristics. Herein, we review the lasted advance in adsorptive carbon-based materials for biomedical application with emphasis on carbon nanotubes (CNTs)-based, graphene-based, and biomass/polymer-based ones. We begin with the classification of different carbon-based materials and elaborate the respective preparation approaches that are utilized to realize optimized microstructure and physicochemical property. Afterwards, we introduce the different applications of carbon-based materials in biomedical arena, including blood purification, enrichment of glycopeptide and phosphopeptide, and breath analysis. Finally, we present a concise summary and give an outlook of this arena.

Background Nafamostat mesilate (NM), a broad-spectrum and potent serine protease inhibitor, can be used as an anticoagulant during extracorporeal circulation, as well as a promising drug effective against coronavirus disease 2019 (COVID-19). We conducted a systematic meta-analysis to evaluate the safety and efficacy of NM administration in critically ill patients who underwent blood purification therapy (BPT).Methods The Cochrane Library, Web of Science and PubMed were comprehensively searched from inception to August 20, 2021, for potential studies.Results Four randomized controlled trials (RCTs) and seven observational studies with 2723 patients met the inclusion criteria. The meta-analysis demonstrated that conventional therapy (CT) significantly increased hospital mortality compared with NM administration (RR = 1.25, p = 0.0007). In subgroup analyses, the in-hospital mortality of the NM group was significantly lower than that of the anticoagulant-free (NA) group (RR = 1.31, p = 0.002). The CT interventions markedly elevated the risk ratio of bleeding complications by 45% (RR = 1.45, p = 0.010) compared with NM interventions. In another subgroup analysis, NM used exhibited a significantly lower risk of bleeding complications than those of the low-molecular-weight heparin (LMWH) used (RR = 4.58, p = 0.020). The filter lifespan was decreased significantly (MD = −10.59, p

Abstract Background Severe pregabalin intoxication may cause serious symptoms, such as coma. Since pregabalin is a small molecule with no protein binding sites and has low volume of distribution, hemodialysis can be effective in eliminating pregabalin from the blood. However, in cases of emergency, it is not always possible to perform hemodialysis because of limited availability and time delay associated with using the plumbing equipment. Continuous hemodiafiltration (CHDF) can be performed without plumbing equipment; however, the knowledge on the effectiveness of CHDF in pregabalin elimination is insufficient. Case presentation A septuagenarian woman with normal renal function was found in a collapsed state with symptoms of coma and miosis. Empty medical bags of pregabalin (2350 mg), bepotastine besilate (600 mg), celecoxib (4600 mg), quetiapine fumarate (87.5 mg), clotiazepam (180 mg), and teprenone (50 mg) were found around her. During the patient's transfer to our hospital, her cognition worsened and she developed glossoptosis necessitating her emergent intubation upon arrival. We considered that the coma was mainly caused by pregabalin intoxication and were concerned about the consequent critical comorbidities. Thus, we performed CHDF in a high-flow setting in our intensive care unit for pregabalin elimination. After 8 h of CHDF, the patient regained consciousness, and after 6.5 h we extubated her. At a later date, we measured her serum pregabalin levels during the clinical course and estimated the blood pregabalin clearance levels depending on her metabolism as 76.8 mL/min and depending on CHDF itself as 65.1 mL/min. Based on these findings, we concluded that CHDF contributed to reducing blood pregabalin levels in this patient. Conclusions Our case revealed that pregabalin clearance using CHDF is similar to metabolic clearance in patients with normal renal function, indicating that CHDF decreases blood pregabalin levels and can be a potential treatment for severe pregabalin intoxication.

Abstract Background The Japan Society for Blood Purification in Critical Care (JSBPCC) has reported survey results on blood purification therapy (BPT) for critically ill patients in 2005, 2009, and 2013. To clarify the current clinical status, including details of the modes used, treated diseases, and survival rate, we conducted this cohort study using data from the nationwide JSBPCC registry in 2018. Methods We analyzed data of 2371 patients who underwent BPT in the intensive care units of 43 facilities to investigate patient characteristics, disease severity, modes of BPTs, including the dose of continuous renal replacement therapy (CRRT) and hemofilters, treated diseases, and the survival rate for each disease. Disease severity was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores. Results BPT was performed 2867 times in the 2371 patients. Mean APACHE II and SOFA scores were 23.5 ± 9.4 and 10.0 ± 4.4, respectively. The most frequently used mode of BPT was CRRT (67.4%), followed by intermittent renal replacement therapy (19.1%) and direct hemoperfusion with the polymyxin B-immobilized fiber column (7.3%). The most commonly used anticoagulant was nafamostat mesilate (78.6%). Among all patients, the 28-day survival rate was 61.7%. CRRT was the most commonly used mode for many diseases, including acute kidney injury (AKI), multiple organ failure (MOF), and sepsis. The survival rate decreased according to the severity of AKI (P = 0.001). The survival rate was significantly lower in patients with multiple organ failure (MOF) (34.6%) compared with acute lung injury (ALI) (48.0%) and sepsis (58.0%). Multivariate logistic regression analysis revealed that sepsis, ALI, acute liver failure, cardiovascular hypotension, central nervous system disorders, and higher APACHE II scores were significant predictors of higher 28-day mortality. Conclusion This large-scale cohort study revealed the current status of BPT in Japan. It was found that CRRT was the most frequently used mode for critically ill patients in Japan and that 28-day survival was lower in those with MOF or sepsis. Further investigations are required to clarify the efficacy of BPT for critically ill patients. Trial Registration : UMIN000027678.

Case series summary: A 2-year-old female spayed Abyssinian cat was evaluated for lethargy and inappetence that first occurred approximately 4 days prior. In addition, urination had not been observed by the owner for 5 days. A Lilium species plant had been brought into the house approximately 5 days before initial evaluation, and intoxication was therefore suspected. Bloodwork revealed anemia, severe azotemia and hyperkalemia. As the cat was anuric with severe azotemia, hyperkalemia and fluid overload, intermittent hemodialysis was recommended. Attempts were made to place a hemodialysis catheter into the external jugular veins bilaterally, but after initial successful venipuncture, the instrumentation would not pass into either vein. During fluoroscopic angiography, no internal jugular veins or external jugular veins caudal to the thoracic inlet were visualized and venous drainage from the head occurred via the vertebral veins. Owing to the anomalous anatomy in the cervical region, a hemodialysis catheter could not be placed into either jugular vein. Alternative sites for the placement of an extracorporeal catheter were discussed with the owner, but humane euthanasia was elected. Relevance and novel information: To the authors' knowledge, this is the first report of a cat with bilateral external jugular vein anomalies resulting in blind endings that did not communicate with the vena cava. This was discovered during attempts to place a hemodialysis catheter for the management of anuric renal failure secondary to Lilium species intoxication. While this anatomical variation is likely uncommon, it is an important differential to consider when faced with challenging external jugular vein catheterizations in feline patients. [ABSTRACT FROM AUTHOR]

BackgroundThere is a lack of data to support the use of hemoadsorption in pediatric septic shock. The aim of our study was to assess the effectiveness and safety of CytoSorb therapy in this setting.MethodsPhase II interventional single arm pilot study in which 17 consecutive children admitted with septic shock who required continuous kidney replacement therapy (CKRT) and weighed ≥10 kg were included. A CytoSorb (CytoSorbents Inc, New Jersey, USA) hemoadsorption cartridge was added to the CKRT every 24 h for a maximum of 96 h. A control group of 13 children with septic shock treated with CKRT but not hemoadsorption at Children's Hospital Bambino Gesù and enrolled in the EuroAKId register was selected as an historical cohort. The primary outcome of the study was a reduction in vasopressor or inotrope dose of >50% from baseline by the end of CytoSorb therapy. Secondary outcomes included hemodynamic and biological changes, changes in severity scores, and 28-day mortality.ResultsThere were significant decreases in the Vasoactive Inotropic Score (VIS) and the Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score at 72 and 96 h from the start of the CytoSorb therapy compared to baseline; the reductions were larger in the hemoadsorption group than in the control group (historical cohort). 28-day mortality was lower, although not significantly, in the hemoadsorption group when compared to the control group (5/17 [29%] vs. 8/13 [61%] OR 0.26 [95% CI: 0.05–1.2]; p = 0.08).ConclusionsCytoSorb therapy may have some benefits in pediatric patients with septic shock. Future larger randomized trials are needed in this setting. Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT05658588, identifier (Clinicaltrials.gov NCT05658588).

Benzodiazepine ingestion is frequent in patients admitted to ICU for intoxications. Generally, a supportive approach by securing the airway, breathing, and circulation is sufficient. Flumazenil is a well-known antidote for benzodiazepines but does not influence its elimination. Following preclinical data, we applied for the first time in humans a hemadsorption filter in a patient with a bromazepam intoxication. This technique proved to be effective in eliminating bromazepam in a patient with CHILD-C cirrhosis. We conclude that hemadsorption is a viable option to reduce length of ICU stay or intubation in slow metabolizers without contraindications.

This paper summarized the experience of nursing measures for a neonate with multiple organ dysfunction syndrome treated by continuous blood purification. Key issues of nursing included central venous catheter insertion and maintenance, strict monitoring of vital signs, regular testing of internal environment of the body, monitoring of indexes of blood filter, prevention of hypothermia, hypotension, hemorrhage and blood coagulation, strengthening the sedation and analgesia, and airway management. (本文总结血液净化治疗1例新生儿多器官功能障碍的护理经验, 包括中心静脉导管置管及维护, 严格记录生命体征, 定期检测内环境, 密切监测血滤机各压力值、血流速, 积极预防低体温、低血压、出血及凝血等并发症, 镇静镇痛及管道护理等。)