Проблемы при использовании адсорбера CytoSorb® у пациента интенсивной терапии с нарушением функции печени

Hi Everyone

Please find attached and below a recent case report supporting our message of frequent adsorber exchanges and therapeutic drug monitoring in a patient with severe liver failure.

Kind regards

Teresa and Harriet

Challenges in the use of the CytoSorb® adsorber in an intensive care patient with liver dysfunction of unknown origin: a case report

Grafe C, Paal M, Irlbeck M, Liebchen U, Scharf C, Graf H.

J Med Case Rep 2025; 19(1):440

Case Overview

This is the case of a 26-year-old man who experienced severe postoperative complications after a lung transplant. Despite successful surgery, he developed massive bleeding and later severe liver failure of unknown origin, characterized by highly elevated bile acids.

Use of CytoSorb®

Indication: Due to the elevated bile acids and severe hepatic dysfunction, clinicians opted to use the CytoSorb® cytokine adsorber.

Therapeutic Adjustments

Vancomycin Dosing

·         Since CytoSorb® can remove vancomycin from the circulation, clinicians increased dosing and closely monitored blood levels to prevent underdosing—especially critical in immunosuppressed transplant patients.

Cartridge Replacement Strategy

·         To avoid premature saturation and maintain efficient adsorption of bile acids, the adsorber cartridge was replaced every 8 hours 
 

Clinical Outcomes

·         Bile acids: Continuous reduction achieved during therapy (228 µmol/L – 97.4 µmol/L)

·         Vancomycin levels: Remained stable due to adjusted dosing.

·         Safety: No significant adverse effects reported from CytoSorb® use under this modified regimen.

Key Lessons

The authors highlight two main clinical insights for CytoSorb® application in ICU patients with hepatic dysfunction:

·         Frequent cartridge changes are crucial to avoid rapid saturation and maintain effectiveness.

·         Drug-level monitoring and dose adjustments (e.g., vancomycin) are essential to prevent underdosing during hemadsorption therapy.

·         This personalized strategy helped balance efficacy and safety.

Ключевые слова: КОМЕСА, CytoSorb