Abstract
This article will briefly highlight some aspects of extracorporeal blood purification in intensive care of cardiac surgery. Over the past decades, there have been tremendous changes in the approach to the use of blood purification in critically ill patients. Many blood purification methods are used for a number of pathological conditions. New promising technologies for blood purification appear today. This area of medicine is developing and spreading to different clinical directions.
The use of each method of blood purification in cardiac surgery requires careful research to assess not only the effectiveness, but also the safety of the procedure. The development of indications and a protocol for each method of blood purification, depending on the technology of mass transfer (convection, diffusion, filtration, sorption, and apheresis) in intensive care is fundamental.
References
- Ronco C., Ricci Z., De Backer D., Kellum J.A., Taccone F.S., Joannidis M. et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit. Care. 2015; 19: 146. DOI: 10.1186/s13054-015- 0850-8
- Bellomo R., Ronco C. Continuous renal replacement therapy: hemofiltration, hemodiafiltration or hemodialysis. In: Ronco C., Bellomo R., Kellum J.A. (Eds). Critcal Care Nephrology. 2nd ed. Philadelphia: Saunders Elsevier; 2009: 1354–8.
- Hoste E.A., Kellum J.A. Incidence, classification, and outcomes of acute kidney injury. Contrib. Nephrol. 2007; 156: 32–8.
- Palevsky P.M. Renal replacement therapy in acute kidney injury. Adv. Chronic. Kidney Dis. 2013; 20 (1): 76–84. DOI: 10.1053/j.ackd.2012.09.004
- Yarustovskii M.B., Grigor'yants R.G., Strakhov D.G., Banketov Ya.V., Geptner R.A., Abramyan M.V. et al. A modern version of intermittent renal replacement therapy in patients with multiple organ dysfunction syndrome after surgery on the heart and blood vessels. Russian Journal of Anesthesiology and Reanimatology. 2002; 1: 49–54 (in Russ.).
- Pankratenko T.E., Muzurov A.L., Zverev D.V., Abaseeva T.Yu., Lifshic V.I., Emirova Kh.M. Renal replacement therapy in babies with acute and chronic renal failure. Nephrology and Dialysis. 2012; 1: 48–56 (in Russ.).
- Ponce D., Balbi A.L., Amerling R. Advances in peritoneal dialysis in acute kidney injury. Blood Purif. 2012; 34: 107–16. DOI: 10.1159/000341648
- Yarustovskij M.B., Abramyan M.V., Komardina E.V. Methods of molecular transfusion in intensive care of critical states in pediatric postoperative cardiac surgery patients. Annals of the Russian Academy of Medical Sciences. 2016; 71 (5): 341–9 (in Russ.). DOI: 10.15690/vramn709
- Yarustovskij M.B., Abramyan M.V., Krotenko N.P., Komardina E.V. Methods of molecular transfusion in the intensive therapy of critical states. Annals of the Russian Academy of Medical Sciences. 2016; 71 (4): 281–7 (in Russ.). DOI: 10.15690/vramn680
- Yaroustovsky M., Abramyan M., Komardina E., Nazarova E. Blood purification in intensive care patients with multiple organ dysfunction syndrome and sepsis after cardiac surgery. Vessel Plus. 2017; 1: 49–60.
- Kaukonen K.M., Bailey M., Suzuki S., Pilcher D., Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014; 311 (13): 1308–16. DOI: 10.1001/jama.2014.2637
- Zhou F., Peng Z., Murugan R., Kellum J.A. Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit. Care. Med. 2013; 41 (9): 2209–20. DOI: 10.1097/CCM.0b013e31828cf412
- Marshall J.C. Endotoxin in the pathogenesis of sepsis. Contrib. Nephrol. 2010; 167: 1–13. DOI: 10.1159/000315914
- Popov D.A., Vostrikova T.Yu. Microbiological monitoring in a cardiac surgery hospital – 10 years of experience. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2012; 13 (5): 68–76 (in Russ.).
- Bosmann M., Ward P.A. The inflammatory response in sepsis. Trends Immunol. 2013; 34 (3): 129–36. DOI: 10.1016/j.it.2012.09.004
- Yaroustovsky M., Abramyan M., Krotenko N., Popov D., Plyushch M., Popok Z. Endotoxin adsorption using polymyxin B immobilized fiber cartridges in severe sepsis patients following cardiac surgery. Int. J. Artif. Organs. 2014; 37 (4): 299–307. DOI: 10.5301/ijao.5000322
- Yaroustovsky M., Abramyan M., Krotenko N., Popov D., Plyushch M., Rogalskaya E. A pilot study of selective lipopolysaccharide adsorption and coupled plasma filtration and adsorption in adult patients with severe sepsis. Blood Purif. 2015; 39: 210–7. DOI: 10.1159/000371754
- Yaroustovsky M., Abramyan M., Krotenko N., Popov D., Plyushch M., Rogalskaya E. et al. Combined extracorporeal therapy for severe sepsis in patients after cardiac surgery. Blood Purif. 2014; 37 (1): 39–46. DOI: 10.1159/000357015
- Yarustovskij M.B., Abramyan M.V., Krotenko N.P., Popov D.A., Plyushch M.G., Gordeev S.L. et al. The new concept of combined use of extracorporeal blood correction in complex intensive therapy of severe sepsis in patients after cardiac surgery. Anesthesiology and Reanimatology. 2015; 60 (5): 75–80 (in Russ.).
- Yarustovskij M.B., Abramyan M.V., Krotenko N.P., Plyushch M.G., Popov D.A., Rogal'skaya E.A. et al. Etiopathogenetic extracorporeal treatment of severe sepsis in patients after cardiac surgery. Anesthesiology and Reanimatology. 2013; 5: 34–41 (in Russ.).
- Nakamura Y., Kitamura T., Kiyomi F., Hayakawa M., Hoshino K., Kawano Y. et al. and Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study group. Potential survival benefit of polymyxin B hemoperfusion in patients with septic shock: a propensity-matched cohort study. Crit. Care. 2017; 21: 134. DOI: 10.1186/s13054-017-1712-3
- Shoji H. Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). Ther. Aher. Dial. 2003; 7: 108–14.
- Formica M., Olivieri C., Livigni S., Cesano G., Vallero A., Maio M. et al. Hemodynamic response to coupled plasmafiltration adsorption in human septic shock. Intensive Care. Med. 2003; 29: 703–8.
- Berlot G., Agbedjro A., Tomasini A., Bianco F., Gerini U., Viviani M. et al. Effects of the volume of processed plasma on the outcome, arterial pressure and blood procalcitonin levels in patients with severe sepsis and septic shock treated with coupled plasma filtration and adsorption. Blood Purif. 2014; 37 (2): 146–51. DOI: 10.1159/000360268
- Naka T., Haase M., Bellomo R. “Super high-flux” or “high cut-off” hemofiltration and hemodialysis. Contrib. Nephrol. 2010; 166: 181–9. DOI: 10.1159/000314871
- Morgera S., Haase M., Kuss T., Vargas-Hein O., Zuckermann-Becker H., Melzer C. et al. Pilot study of the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with ARF. Crit. Care. Med. 2006; 34 (8): 2099–104.
- Liu J.P., Wang X.W., Qie L.P. Disease indicators for sepsis and analysis of sepsis treatment in children using the continuous blood purification technique. Genet. Mol. Res. 2015; 4 (2): 5685–93. DOI: 10.4238/2015
- Hirakawa E., Ibara S., Tokuhisa T. et al. Septic neonate rescued by polymyxin B hemoperfusion. Pediatr. Int. 2013; 55 (3): e70–2.
- Yaroustovsky M., Abramyan M., Komardina E., Nazarova H., Popov D., Plyushch M. et al. Selective LPS adsorption using polymyxin B-immobilized fiber cartridges in sepsis patients following cardiac surgery. SHOCK. 2018; 49 (6): 658–66.
- Nishizaki N., Hara T., Obinata K., Nakagawa M., Shimizu T. Clinical effects and outcomes after Polymyxin B-immobilized fiber column direct hemoperfusion treatment for septic shock in preterm neonates. Pediatr. Crit. Care Med. 2020; 21 (2): 156–63. DOI: 10.1097/PCC.0000000000002132
- Yaroustovsky M., Abramyan M., Komardina E., Rogalskay E. Selective polymyxin hemoperfusion in complex therapy of sepsis in children after cardiac surgery. Blood Purif. 2021; 50 (2): 222–9. DOI: 10.1159/000510126
- Yarustovsky M.B., Abramyan M.V., Soldatkina A.O., Komardina E.V., Nazarova E.I., Plyushch M.G. et al. Preliminary report regarding the use of LPS-adsorption in complex intensive therapy for children with gram-negative sepsis after heart surgery. Anesthesiology and Reanimatology. 2017; 62 (5): 376–81 (in Russ.). DOI: 10.18821/0201-7563-2017-62-5-376-381
- Morishita Y., Kita Y., Ohtake K., Kusano E., Hishikawa S., Mizuta K. et al. Successful treatment of sepsis with polymyxin b-immobilized fiber hemoperfusion in a child after living donor liver transplantation. Dig. Dis. Sci. 2005; 50 (4): 757. PMID: 15844714 34. Saliba F., Camus C., Durand F., Mathurin P., Letierce A., Delafosse B. et al. Albumin dialysis with a noncell artificial liver support device in patients with acute liver failure: a randomized, controlled trial. Ann. Intern. Med. 2013; 159 (8): 522–31.
- Stange J., Hassanein T.I., Mehta R., Mitzner S.R., Bartlett R.H. The molecular adsorbent recycling system as a liver support system based on albumin dialysis: a summary of preclinical investigations, prospective, randomized, controlled clinical trial and clinical experience from 19 centers. Artif. Organs. 2002; 26 (2): 103–40.
- Mitzner S.R., Stange J., Klammt S. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J. Am. Soc. Nephrol. 2001; 12 (Suppl. 17): 75–82.
- Oppert M., Rademacher S., Petrasch K., Jörres A. Extracorporeal liver support therapy with Prometheus in patients with liver failure in the intensive care unit. Ther. Apher. Dial. 2009; 13 (5): 426–30.
- Yarustovskij M.B., Abramyan M.V., Komardina E.V., Rep'eva E.V., Nazarova E.I., Krotenko N.P. et al. Artificial liver support devices in patients with acute liver failure after cardiac surgery. Anesthesiology and Reanimatology. 2014; 5: 4–10 (in Russ.).
- Komardina E., Yaroustovsky M., Abramyan M., Plyushch M. Prometheus therapy for the treatment of acute liver failure in patients after cardiac surgery. Kardiochir. Torakochir. Polska. 2017; 14 (4): 230–5. DOI: 10.5114/kitp.2017.72226
- Gong D., Ji D., Zhu D., Xu B., Liu Z. Efficient removal of serum bilirubin by a novel artificial liver support system using albumin convection: a pilot study. Blood Purif. 2012; 34 (3–4): 201–8. DOI: 10.1159/000342111
- Donati G., La Manna G., Cianciolo G., Grandinetti V., Carretta E., Cappuccilli M. et al. Extracorporeal detoxification for hepatic failure using molecular adsorbent recirculating system: depurative efficiency and clinical results in a long-term follow-up. Artif. Organs. 2014; 38 (2): 125–34. DOI: 10.1111/aor.12106 42. Grodzicki M., Kotulski M., Leonowicz D., Zieniewicz K., Krawczyk M. Results of treatment of acute liver failure patients with use of the prometheus FPSA system. Transplant. Proc. 2009; 41 (8): 3079–81. DOI: 10.1016/j.transproceed.2009.08.024
- Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J. Am. Coll. Cardiol. 2017; 69 (6): 692–711. DOI: 10.1016/j.jacc.2016.11.042
- Yaroustovsky M.B., Abramyan M.V. Significance of lipoprotein (a) in the pathogenesis of cardiovascular diseases. Creative Cardiology. 2019; 13 (1): 40–51 (in Russ.). DOI: 10.24022/1997-3187-2019-13-1-40-51
- Julius U. Current role of lipoprotein apheresis in the treatment of high-risk patients. J. Cardiovasc. Dev. Dis. 2018; 5: 27. DOI: 10.3390/jcdd5020027
- Abramyan M.V. Possibilities of LDL-apheresis in complex treatment of atherosclerosis. Creative Cardiology. 2007; 1–2: 208–19 (in Russ.).
- Yaroustovsky M.B., Abramyan M.V., Rogal'skaya E.A., Komardina E.V., Nazarova E.I., Grigoryan D.A. et al. Possibilities of correction of elevated lipoprotein (a) levels. Creative Cardiology. 2019; 13 (2): 129–46 (in Russ.). DOI: 10.24022/1997-3187-2019-13-2-129-146
- Yaroustovsky M.B., Abramyan M.V., Plyushch M.G., Samsonova N.N., Nazarova E.I., Stupchenko O.S. New medical technologies in cardiovascular surgery. Treatment of atherosclerosis and its complications with the method of H.E.L.P.-apheresis. Creative Cardiology. 2009; 2: 98–116 (in Russ.).
About the authors
- Mikhail B. Yaroustovsky, Dr. Med. Sc., Professor, Corresponding Member of RAS, Head of Department of Blood Purification and Endoscopy, Deputy Director; ORCID
- Marina V. Abramyan, Cand. Med. Sc., Leading Researcher; ORCID
- Ekaterina V. Komardina, Junior Researcher; ORCID
- Elena I. Nazarova, Transfusiologist; ORCID
