TY - JOUR
T1 - Evaluation of the cytosorbtm hemoadsorptive column in a pig model of severe smoke and burn injury
AU - Linden, Katharina
AU - Scaravilli, Vittorio
AU - Kreyer, Stefan F.X.
AU - Belenkiy, Slava M.
AU - Stewart, Ian J.
AU - Chung, Kevin K.
AU - Cancio, Leopoldo C.
AU - Batchinsky, Andriy I.
N1 - Publisher Copyright:
© 2015 by the Shock Society.
PY - 2015
Y1 - 2015
N2 - Introduction: Host inflammatory response to any form of tissue injury, including burn, trauma, or shock, has been well documented. After significant burns, cytokines can increase substantially within the first 24 h after injury and may contribute to subsequent organ failure. Hemoadsorption by cytokine-adsorbing columns may attenuate this maladaptive response, thereby improving outcomes. The aim of this study was to investigate the feasibility, technical safety, and efficacy of cytokine and myoglobin removal by early use of a cytokine absorbing column (CytoSorb) in a porcine model of smoke inhalation and burn injury. Methods: Anesthetized female Yorkshire pigs (n=15) were injured by wood bark smoke inhalation and a 40% total body surface area deep burn and observed for 72 h or death. The animals were randomized to hemoadsorption treatment (n=9) or a sham group (n=6) before injury. A 6-h hemoadsorption or sham session was performed on days one, two, and three. Serum cytokines (IL-1b, IL-6, IL-8, IL-10, TNF-alpha) and myoglobin were measured systemically, locally in bronchoalveolar lavage fluid and also in circulating blood before and after the adsorbing column to evaluate single pass clearance by the device. Results: Hemoadsorption caused significant removal of IL-1b, IL-6, IL-10, and myoglobin across the device mainly during the first run, ranging from 22% for IL-6 to 29% for IL-1b and 41% removal rates for myoglobin after 15 min of treatment. Systemic cytokine or myoglobin serum concentrations did not change. Conclusions: In a porcine model of smoke and burn injury, hemoadsorption using the CytoSorb cartridge did not result in significant systemic or pulmonary reductions in the measured cytokines or myoglobin despite efficient transmembrane reductions. Further investigations are needed to optimize the efficiency of mediator clearance to affect both circulating levels and clinically relevant outcomes.
AB - Introduction: Host inflammatory response to any form of tissue injury, including burn, trauma, or shock, has been well documented. After significant burns, cytokines can increase substantially within the first 24 h after injury and may contribute to subsequent organ failure. Hemoadsorption by cytokine-adsorbing columns may attenuate this maladaptive response, thereby improving outcomes. The aim of this study was to investigate the feasibility, technical safety, and efficacy of cytokine and myoglobin removal by early use of a cytokine absorbing column (CytoSorb) in a porcine model of smoke inhalation and burn injury. Methods: Anesthetized female Yorkshire pigs (n=15) were injured by wood bark smoke inhalation and a 40% total body surface area deep burn and observed for 72 h or death. The animals were randomized to hemoadsorption treatment (n=9) or a sham group (n=6) before injury. A 6-h hemoadsorption or sham session was performed on days one, two, and three. Serum cytokines (IL-1b, IL-6, IL-8, IL-10, TNF-alpha) and myoglobin were measured systemically, locally in bronchoalveolar lavage fluid and also in circulating blood before and after the adsorbing column to evaluate single pass clearance by the device. Results: Hemoadsorption caused significant removal of IL-1b, IL-6, IL-10, and myoglobin across the device mainly during the first run, ranging from 22% for IL-6 to 29% for IL-1b and 41% removal rates for myoglobin after 15 min of treatment. Systemic cytokine or myoglobin serum concentrations did not change. Conclusions: In a porcine model of smoke and burn injury, hemoadsorption using the CytoSorb cartridge did not result in significant systemic or pulmonary reductions in the measured cytokines or myoglobin despite efficient transmembrane reductions. Further investigations are needed to optimize the efficiency of mediator clearance to affect both circulating levels and clinically relevant outcomes.
KW - Blood purification
KW - Burns
KW - Cytokine removal
KW - Hemoadsorption
KW - Myoglobin removal
KW - Respiratory failure
UR - http://www.scopus.com/inward/record.url?scp=84945188739&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000000439
DO - 10.1097/SHK.0000000000000439
M3 - Article
C2 - 26368927
AN - SCOPUS:84945188739
SN - 1073-2322
VL - 44
SP - 487
EP - 495
JO - Shock
JF - Shock
IS - 5
ER -