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  1. Article: Impact of CytoSorb Hemoadsorption Therapy on Fluid Balance in Patients with Septic Shock.

    Kogelmann, Klaus / Hübner, Tobias / Drüner, Matthias / Jarczak, Dominik

    Journal of clinical medicine

    2024  Volume 13, Issue 1

    Abstract: Recent in vitro studies have investigated the effects of hemoadsorption therapy on endothelial function in sepsis showing a reduction in markers of endothelial dysfunction, but, to this day, there are no clinical studies proving whether this approach ... ...

    Abstract Recent in vitro studies have investigated the effects of hemoadsorption therapy on endothelial function in sepsis showing a reduction in markers of endothelial dysfunction, but, to this day, there are no clinical studies proving whether this approach could actually positively influence the disturbed vascular barrier function in septic conditions. We retrospectively analyzed data on administered fluid volumes and catecholamines in 124 septic shock patients. We collected catecholamine and volume requirements and calculated the volume balance within different time periods to obtain an assumption on the stability of the vascular barrier. Regarding the entire study cohort, our findings revealed a significant reduction in fluid balance at 72 h (T
    Language English
    Publishing date 2024-01-04
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13010294
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Reply to Supady et al. On the Use of Hemadsorption with CytoSorb in Patients with Septic Shock. Comment on "Kogelmann et al. First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock.

    Kogelmann, Klaus / Hübner, Tobias / Schwameis, Franz / Drüner, Matthias / Scheller, Morten / Jarczak, Dominik

    Journal of clinical medicine

    2022  Volume 11, Issue 5

    Abstract: Thank you very much for your interest in our research [ ... ]. ...

    Abstract Thank you very much for your interest in our research [...].
    Language English
    Publishing date 2022-02-23
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11051192
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Use of hemoadsorption in sepsis-associated ECMO-dependent severe ARDS: A case series.

    Kogelmann, Klaus / Scheller, Morten / Drüner, Matthias / Jarczak, Dominik

    Journal of the Intensive Care Society

    2019  Volume 21, Issue 2, Page(s) 183–190

    Abstract: Introduction: Acute respiratory distress syndrome in the context of severe sepsis and septic shock represents a serious clinical disorder. A recent case series in patients with septic shock and renal failure receiving hemoadsorption treatment showed ... ...

    Abstract Introduction: Acute respiratory distress syndrome in the context of severe sepsis and septic shock represents a serious clinical disorder. A recent case series in patients with septic shock and renal failure receiving hemoadsorption treatment showed rapid hemodynamic stabilization and increased survival, particularly in pneumonia patients and in those where therapy was started early. We hypothesized that patients suffering from pneumonia and refractory acute respiratory distress syndrome to the extent that they required extracorporeal membrane oxygenation support could possibly demonstrate the most pronounced benefit from the treatment.
    Methods: We assessed the association of hemoadsorption treatment with hemodynamics, ventilation, and outcome variables in a set of patients with septic shock, acute respiratory distress syndrome, need for veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy.
    Results: Key observations include a significant stabilization in hemodynamics as evidenced by a marked decrease in catecholamine need, which was paralleled by a clear reduction in hyperlactatemia. Respiratory variables improved significantly. In addition, severity of illness and overall organ dysfunction showed a considerable decrease during the course of treatment. Observed mortality was approximately half as predicted by APACHE II. Treatment with CytoSorb was safe and well tolerated with no device-related adverse events.
    Discussion: This is the first case series reporting on outcome variables associated to CytoSorb therapy in critically ill patients with septic shock, acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation, and continuous renal replacement therapy. Based on our observations in this small case series, CytoSorb might represent a potentially promising therapy option for patients with refractory extracorporeal membrane oxygenation-dependent acute respiratory distress syndrome in the context of septic shock.
    Language English
    Publishing date 2019-01-08
    Publishing country England
    Document type Case Reports
    ZDB-ID 2701626-2
    ISSN 1751-1437 ; 1751-1437
    ISSN (online) 1751-1437
    ISSN 1751-1437
    DOI 10.1177/1751143718818992
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  4. Article: First Evaluation of a New Dynamic Scoring System Intended to Support Prescription of Adjuvant CytoSorb Hemoadsorption Therapy in Patients with Septic Shock.

    Kogelmann, Klaus / Hübner, Tobias / Schwameis, Franz / Drüner, Matthias / Scheller, Morten / Jarczak, Dominik

    Journal of clinical medicine

    2021  Volume 10, Issue 13

    Abstract: Introduction: Despite advances in critical care medicine, adjunctive approaches in sepsis therapy have failed to prove their efficacy. Notwithstanding promising results using hemoadsorption (CytoSorb), questions remain concerning timing and dosing. We ... ...

    Abstract Introduction: Despite advances in critical care medicine, adjunctive approaches in sepsis therapy have failed to prove their efficacy. Notwithstanding promising results using hemoadsorption (CytoSorb), questions remain concerning timing and dosing. We created a dynamic scoring system (DSS) to assess patients with early septic shock and performed a first evaluation of the system in this patient population.
    Methods: Data from 502 patients with septic shock according to Sepsis-3 criteria were retrospectively analyzed. Score parameters were documented at the time of diagnosis (T
    Results: Of the 502 patients analyzed, 198 received adjunctive CytoSorb treatment and 304 received standard therapy. Septic shock was typically represented by 5 points, while >6 points indicated a situation refractory to standard therapy with the worst outcome in patients shown by >8 points. The differences in mortality between the score groups (<6, 6-8, >8 points) were significant. Analysis further showed a significant 56-day, ICU and hospital survival advantage in CytoSorb patients when therapy was started early.
    Conclusion: We created a scoring system allowing for the assessment of the clinical development of patients in the early phase of septic shock. Applying this approach, we were able to detect populations with a distinct mortality pattern. The data also showed that an early start of CytoSorb therapy was associated with significantly improved survival. As a next step, this easy-to-apply scoring system would require validation in a prospective manner to learn whether patients to be treated with hemoadsorption therapy in the course of septic shock could thereby be identified.
    Language English
    Publishing date 2021-06-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm10132939
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Hemoadsorption by CytoSorb in septic patients: a case series.

    Kogelmann, Klaus / Jarczak, Dominik / Scheller, Morten / Drüner, Matthias

    Critical care (London, England)

    2017  Volume 21, Issue 1, Page(s) 74

    Abstract: Background: Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks ...

    Abstract Background: Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis.
    Methods: In the present case series, we evaluated the impact of a new hemoadsorption device (CytoSorb) used as adjunctive therapy, on hemodynamics and clinically relevant outcome parameters in 26 critically ill patients with septic shock and in need of renal replacement therapy.
    Results: We found that treatment of these patients with septic shock was associated with hemodynamic stabilization and a reduction in blood lactate levels. Actual mortality in the overall patient population was lower than mortality predicted by acute physiology and chronic health evaluation II (APACHE II). These effects seem to be more pronounced in patients in whom therapy started within 24 h of sepsis diagnosis, whereas a delay in the start of therapy was associated with a poor response to therapy in terms of reduction of catecholamine demand and survival. Moreover, from our patient population, medical patients seemed to benefit more than post-surgical patients in terms of survival. Treatment using the CytoSorb device was safe and well-tolerated with no device-related adverse events during or after the treatment sessions.
    Conclusion: Hemoadsorption using CytoSorb resulted in rapid hemodynamic stabilization and increased survival, particularly in patients in whom therapy was started early. Given the positive clinical experience of this case series, randomized controlled trials are urgently needed to define the potential benefits of this new treatment option.
    Language English
    Publishing date 2017--27
    Publishing country England
    Document type Journal Article
    ZDB-ID 2051256-9
    ISSN 1466-609X ; 1466-609X
    ISSN (online) 1466-609X
    ISSN 1466-609X
    DOI 10.1186/s13054-017-1662-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Inhaled isoflurane via the anaesthetic conserving device versus propofol for sedation of invasively ventilated patients in intensive care units in Germany and Slovenia: an open-label, phase 3, randomised controlled, non-inferiority trial.

    Meiser, Andreas / Volk, Thomas / Wallenborn, Jan / Guenther, Ulf / Becher, Tobias / Bracht, Hendrik / Schwarzkopf, Konrad / Knafelj, Rihard / Faltlhauser, Andreas / Thal, Serge C / Soukup, Jens / Kellner, Patrick / Drüner, Matthias / Vogelsang, Heike / Bellgardt, Martin / Sackey, Peter

    The Lancet. Respiratory medicine

    2021  Volume 9, Issue 11, Page(s) 1231–1240

    Abstract: Background: Previous studies indicate that isoflurane could be useful for the sedation of patients in the intensive care unit (ICU), but prospective studies evaluating isoflurane's efficacy have been small. The aim of this study was to test whether the ... ...

    Abstract Background: Previous studies indicate that isoflurane could be useful for the sedation of patients in the intensive care unit (ICU), but prospective studies evaluating isoflurane's efficacy have been small. The aim of this study was to test whether the sedation with isoflurane was non-inferior to sedation with propofol.
    Methods: This phase 3, randomised, controlled, open-label non-inferiority trial evaluated the efficacy and safety of up to 54 h of isoflurane compared with propofol in adults (aged ≥18 years) who were invasively ventilated in ICUs in Germany (21 sites) and Slovenia (three sites). Patients were randomly assigned (1:1) to isoflurane inhalation via the Sedaconda anaesthetic conserving device (ACD; Sedana Medical AB, Danderyd, Sweden; ACD-L [dead space 100 mL] or ACD-S [dead space 50 mL]) or intravenous propofol infusion (20 mg/mL) for 48 h (range 42-54) using permuted block randomisation with a centralised electronic randomisation system. The primary endpoint was percentage of time in Richmond Agitation-Sedation Scale (RASS) range -1 to -4, assessed in eligible participants with at least 12 h sedation (the per-protocol population), five or more RASS measurements, and no major protocol violations, with a non-inferiority margin of 15%. Key secondary endpoints were opioid requirements, spontaneous breathing, time to wake-up and extubation, and adverse events. Safety was assessed in all patients who received at least one dose. The trial is complete and registered with EudraCT, 2016-004551-67.
    Findings: Between July 2, 2017, and Jan 12, 2020, 338 patients were enrolled and 301 (89%) were randomly assigned to isoflurane (n=150) or propofol (n=151). 146 patients (97%) in each group completed the 24-h follow-up. 146 (97%) patients in the isoflurane group and 148 (98%) of patients in the propofol group were included in the per-protocol analysis of the primary endpoint. Least-squares mean percentage of time in RASS target range was 90·7% (95% CI 86·8-94·6) for isoflurane and 91·1% (87·2-95·1) for propofol. With isoflurane sedation, opioid dose intensity was 29% lower than with propofol for the overall sedation period (0·22 [0·12-0·34] vs 0·32 [0·21-0·42] mg/kg per h morphine equivalent dose, p=0·0036) and spontaneous breathing was more frequent on day 1 (odds ratio [OR] 1·72 [1·12-2·64], generalised mixed linear model p=0·013, with estimated rates of 50% of observations with isoflurane vs 37% with propofol). Extubation times were short and median wake-up was significantly faster after isoflurane on day 2 (20 min [IQR 10-30] vs 30 min [11-120]; Cox regression p=0·0011). The most common adverse events by treatment group (isoflurane vs propofol) were: hypertension (ten [7%] of 150 vs two [1%] of 151), delirium (eight [5%] vs seven [5%]), oliguria (seven [5%] vs six [4%]), and atrial fibrillation (five [3%] vs four [3%]).
    Interpretation: These results support the use of isoflurane in invasively ventilated patients who have a clinical need for sedation.
    Funding: Sedana Medical AB.
    MeSH term(s) Adult ; Anesthetics ; Germany ; Humans ; Hypnotics and Sedatives ; Intensive Care Units ; Isoflurane/therapeutic use ; Propofol/adverse effects ; Prospective Studies ; Respiration, Artificial ; Slovenia
    Chemical Substances Anesthetics ; Hypnotics and Sedatives ; Isoflurane (CYS9AKD70P) ; Propofol (YI7VU623SF)
    Language English
    Publishing date 2021-08-26
    Publishing country England
    Document type Clinical Trial, Phase III ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2686754-0
    ISSN 2213-2619 ; 2213-2600
    ISSN (online) 2213-2619
    ISSN 2213-2600
    DOI 10.1016/S2213-2600(21)00323-4
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    Zs.A 7041: Show issues Location:
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  7. Article ; Online: (1 → 3)-β-D-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial.

    Bloos, Frank / Held, Jürgen / Kluge, Stefan / Simon, Philipp / Kogelmann, Klaus / de Heer, Geraldine / Kuhn, Sven-Olaf / Jarczak, Dominik / Motsch, Johann / Hempel, Gunther / Weiler, Norbert / Weyland, Andreas / Drüner, Matthias / Gründling, Matthias / Meybohm, Patrick / Richter, Daniel / Jaschinski, Ulrich / Moerer, Onnen / Günther, Ulf /
    Schädler, Dirk / Weiss, Raphael / Putensen, Christian / Castellanos, Ixchel / Kurzai, Oliver / Schlattmann, Peter / Cornely, Oliver A / Bauer, Michael / Thomas-Rüddel, Daniel

    Intensive care medicine

    2022  Volume 48, Issue 7, Page(s) 865–875

    Abstract: Purpose: To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal therapy and thereby reduces mortality of sepsis patients with high risk of invasive Candida infection (ICI).: Methods: Multicenter, randomized, controlled ... ...

    Abstract Purpose: To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal therapy and thereby reduces mortality of sepsis patients with high risk of invasive Candida infection (ICI).
    Methods: Multicenter, randomized, controlled trial carried out between September 2016 and September 2019 in 18 intensive care units enrolling adult sepsis patients at high risk for ICI. Patients in the control group received targeted antifungal therapy driven by culture results. In addition to targeted therapy, patients in the BDG group received antifungals if at least one of two consecutive BDG samples taken during the first two study days was ≥ 80 pg/mL. Empirical antifungal therapy was discouraged in both groups. The primary endpoint was 28-day-mortality.
    Results: 339 patients were enrolled. ICI was diagnosed in 48 patients (14.2%) within the first 96 h after enrollment. In the BDG-group, 48.8% (84/172) patients received antifungals during the first 96 h after enrollment and 6% (10/167) patients in the control group. Death until day 28 occurred in 58 of 172 patients (33.7%) in the BDG group and 51 of 167 patients (30.5%) in the control group (relative risk 1.10; 95% confidence interval, 0.80-1.51; p = 0.53). Median time to antifungal therapy was 1.1 [interquartile range (IQR) 1.0-2.2] days in the BDG group and 4.4 (IQR 2.0-9.1, p < 0.01) days in the control group.
    Conclusions: Serum BDG guided antifungal treatment did not improve 28-day mortality among sepsis patients with risk factors for but unexpected low rate of IC. This study cannot comment on the potential benefit of BDG-guidance in a more selected at-risk population.
    MeSH term(s) Adult ; Antifungal Agents/therapeutic use ; Candidiasis, Invasive/drug therapy ; Glucans/therapeutic use ; Humans ; Sensitivity and Specificity ; Sepsis/complications ; Sepsis/drug therapy ; beta-Glucans
    Chemical Substances Antifungal Agents ; Glucans ; beta-Glucans
    Language English
    Publishing date 2022-06-16
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-022-06733-x
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