PREVENTION OF RENAL FAILURE –DUE TO RHABDOMYOLYSIS xxx

A CASE REPORT USING CYTOSORB xi

CLAUS-GEORG KRENN / 2. IX. 2015

2nd INTERNAT. CYTOSORB USERS MEETING - 2015

CGK 2014

- STRATEGIES TO IMPROVE OUTCOME –

PATIENT IDENTIFICATION

IDENTIFICATION

&

RISK STRATIFICATION

… despite SOPs, bundles and guidelines, treatment differs between individuals and centers …

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS

BENCHMARK

CGK 2013

- OUTLINE OF MY CASE (S)

MANAGEMENT OF RHABDOMYOLYSIS

„clinical syndrome characterized by injury to sceletal muscle fibres with

disruption and release of their content to circulation ...

increasing creatinine phosphokinase (CK), lactated dehydrogenase (LDH) and myoglobin levels in serum“

ICU ADMISSION RATE: up to 80%

systemic complications: disseminated intravascular coagulopathy (DIC)

electrolyte shift (cardiac dysrythmias) metabolic acidosis,

hypotension/shock, renal failure

1st INTERNAT. CYTOSORB USER MEETING 2015

CGK 2013

- OUTLINE OF MY CASE (S)

MANAGEMENT OF RHABDOMYOLYSIS treatment of underlying cause (sepsis)

intense hydration with cristalloids, maintainance of polyuria

alkalinisation of urine (pH 6,5 – 7,0) ??

use of (osmotic) diuretics ??

close monitoring of renal function

RENAL REPLACEMENT THERAPYRonco C., Crit Care 2005: 9:141

Brochard L., Am J Resp Crit Care Med 2010; 181: 1128

Petejova N., Crit Care 2014; 18:224

1st INTERNAT. CYTOSORB USER MEETING 2015

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS CGK 2013

CASE REPORT RHABDOMYOLYSIS / CYTOSORB TM

Kuntsevich VI et al., In-Vitro Myoglobin Clearance by a Novel Sorbent System; Artificial Cells, Blood Substitutes, and Biotechnology. 2009;37: 45-47

UNIVERSITY VIENNA CYTOSORBTM EXPERIENCE

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS CGK 2013

CASE REPORT / CYTOSORB TM

Figure 1:decrease of myoglobin levels during cytosorb™ application (1st run: 0-6hours; 2nd run: 9-14hours)

Application of Cytosorb™ system in a patient with legionella-pneumonia associated rhabdomyolysis

Introduction:Rhabdomyolysis has been reported in the context of legionella pneumonia.1,2 Acute renal failure following rhabdomyolysis is a well known complication often indicating hemodialysis. Cytosorb™ was evaluated to reduce toxic levels of cytokines (in e.g. SIRS, sepsis, ARDS, trauma, burn injury) which lead to reduced clinical outcome following organ failure and immune suppression.3,4 Cytokines (10 -50 kDa) are adsorbed by polymer beads within the cartridge.3 The effectiveness of Cytosorb™ to remove myoglobin in vitro from saline solution and donated blood serum respectively has been demonstrated by V.Kuntsevich et al in 2009.5 So far in vivo data are missing.

Diagramm1

18390

14350

11920

12520

10020

9173

13400

9400

9070

8950

8359

Myoglobin levels during Hemoperfusion with Cytosorb™

Tabelle1

0h18390

2h14350

4h11920

6h12520

8h10020

10h9173

16h13400

18h9400

20h9070

22h8950

24h8359

Tabelle1

Tabelle2

Tabelle3

&Lhhhh

myoglobin levels (ng/ml)

myoglobin levels during hemoperfusion with cytosorb™

(POTENTIAL) FIELDS OF APPLICATION / CYTOSORB TM

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS

UNIVERSITY VIENNA CYTOSORB TM EXPERIENCE

CASE 272y-old female patientcollapsed at home, immobility for about 6 hoursanuria, K+ incrase, myoglobin 200.000 ng/ml

CASE 367 y-old male, burn injuryseverely damaged muscle mass despite escherichotomiadeveloped renal failure on day 2 after admission

(POTENTIAL) FIELDS OF APPLICATION / CYTOSORB TM

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS

DIAGNOSIS AND (ADJUVANT) THERAPY OF SEPSIS

UNIVERSITY VIENNA CYTOSORB TM EXPERIENCE

CASE 272y-old female patientcollapsed at home, immobility for about 6 hoursanuria, K+ incrase, myoglobin 200.000 ng/ml

stop of citrate dialysis on day 3adequate urine output (1ml/kg/h) from day 4 on

(support of furosemide 20 mg i.v. / 2x/d)

transfer to normal ward on day 9

… it seems if as if CytoSorb might be a therapeutic option in RRT due to rhabdomyolysis because of its excellent myoglobin binding properties……

CGK 2013

CGK 2013

BETWEEN TOO EARLY AND TOO LATEIS ONLY ONE INSTANT

THANK YOU FOR YOUR ATTENTION

FRANZ WERFEL1890 - 1945

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