背景:败血症性休克是一种严重的败血症,其特征是循环和细胞代谢参数恶化。尽管有标准治疗,结果很差。较新的辅助疗法,如CytoSorb®体外血液吸附装置,已经进行了调查,并显示了有希望的结果。然而,在印度地区,对于使用CytoSorb®血液吸附作为感染性休克辅助治疗的临床决策缺乏一些指导.因此,形成了这一专家共识。
目的:根据现有的最佳证据和印度方案,就使用CytoSorb®血液吸附治疗制定/建立具体的共识声明。
方法:我们对CytoSorb®在脓毒症中的血液吸附进行了全面的文献,2011年1月至2021年3月,PubMed中的败血性休克选择论文以英语发表。共识文件的陈述是基于总结的文献分析和知识差距的识别而制定的。使用结合证据评估和专家意见的改进的德尔菲方法,讨论了以下与CytoSorb®在感染性休克中的相关主题:是否需要辅助治疗,启动时间线,需要白细胞介素-6水平,治疗持续时间,改变吸附器,安全,前提条件,疗效终点和管理流程图。11名重症监护专家,急诊医学,重症监护室参加并投票了九项声明和一个不限成员名额的问题。
结果:11名来自重症监护的专家成员,急诊医学,重症监护室参加并投票了九项声明和一个不限成员名额的问题。共识小组中的所有11名专家(100%)参加了第一个,第二轮和第三轮投票。经过三轮迭代投票和调整两个声明,就九项声明中的九项达成了共识。共识专家小组还认识到有必要成立一个协会或协会,以保持关于使用CytoSorb®用于开放式问题(Q10)中所有适应症的注册,重点是“未来对CytoSorb®治疗的建议”。
结论:这项印度观点的共识声明支持并提供了使用CytoSorb®血液吸附作为感染性休克患者的辅助治疗以达到最佳预后的指导。
BACKGROUND: Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters. Despite standard therapy, the outcomes are poor. Newer adjuvant therapy, such as CytoSorb® extracorporeal haemoadsorption device, has been investigated and shown promising outcome. However, there is a lack of some guidance to make clinical decisions on the use of CytoSorb® haemoadsorption as an adjuvant therapy in septic shock in Indian Setting. Therefore, this expert consensus was formulated.
OBJECTIVE: To formulate/establish specific consensus statements on the use of CytoSorb® haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.
METHODS: We performed a comprehensive literature on CytoSorb® haemoadsorption in sepsis, septic shock in PubMed selecting papers published between January 2011 and March 2023 2021 in English language. The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps. Using a modified Delphi approach combining evidence appraisal and expert opinion, the following topics related to CytoSorb® in septic shock were addressed: need for adjuvant therapy, initiation timeline, need for Interleukin -6 levels, duration of therapy, change of adsorbers, safety, prerequisite condition, efficacy endpoints and management flowchart. Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question.
RESULTS: Eleven expert members from critical care, emergency medicine, and the intensive care participated and voted on nine statements and one open-ended question. All 11 experts in the consensus group (100%) participated in the first, second and third round of voting. After three iterative voting rounds and adapting two statements, consensus was achieved on nine statements out of nine statements. The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb® for all indications in the open-ended question (Q10) focusing on \"future recommendations for CytoSorb® therapy\".
CONCLUSIONS: This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb® haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.