Journal of cardiothoracic and vascular anesthesia · 2026
Oxiris Filter Therapy in Vasoplegic Shock After Cardiac Surgery: A Single-Center Retrospective Study.
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Juvakka Oskar, Svennerholm Kristina, Lannemyr Lukas
Аннотация
OBJECTIVES: Vasoplegia requiring vasoactive inotropic support is a serious complication after cardiac surgery, possibly driven by endotoxin and cytokine release. The aim of this study was to assess if postoperative continuous renal replacement therapy (CRRT) with the Oxiris hemadsorption filter, compared to a standard filter, improves hemodynamic stability.
DESIGN: Investigator-initiated single-center retrospective study.
SETTING: Tertiary cardiothoracic intensive care unit.
PARTICIPANTS: Patients with vasoplegia and need for CRRT within 24 hours after cardiac surgery. Vasoplegia is defined as a cardiac index ≥2.2 L/min/m² and norepinephrine ≥0.60 µg/kg/min to maintain mean arterial pressure ≥65 mmHg.
INTERVENTIONS: Oxiris versus standard CRRT filters (control).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was change in vasoactive inotropic score (VIS) at 48 hours after start of CRRT, analyzed using linear regression adjusted for baseline variables. Secondary outcomes included change in vasopressor requirements, hemodynamic changes, and postoperative outcomes. Fifty-eight patients were included (Oxiris = 30; control = 28), and cardiac transplantation was the most common type of surgery. The Oxiris group had a higher VIS at baseline (113 ± 21 v 101 ± 19, p = 0.020). The Oxiris group showed a significantly greater reduction in VIS compared to controls, with a mean difference of -18.9 (95% CI, -37.3 to -0.4; p = 0.045). This change was primarily driven by reduced norepinephrine doses, with a mean group difference of -0.19 µg/kg/min (95% CI, -0.35 to -0.03; p = 0.019). There were no significant differences in hemodynamic parameters, fluid balance, intensive care unit stay, or 30-day mortality.
CONCLUSIONS: Oxiris filter therapy was associated with a significantly greater reduction in vasoactive inotropic support compared to standard CRRT filters in patients with vasoplegia following cardiac surgery.
DESIGN: Investigator-initiated single-center retrospective study.
SETTING: Tertiary cardiothoracic intensive care unit.
PARTICIPANTS: Patients with vasoplegia and need for CRRT within 24 hours after cardiac surgery. Vasoplegia is defined as a cardiac index ≥2.2 L/min/m² and norepinephrine ≥0.60 µg/kg/min to maintain mean arterial pressure ≥65 mmHg.
INTERVENTIONS: Oxiris versus standard CRRT filters (control).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was change in vasoactive inotropic score (VIS) at 48 hours after start of CRRT, analyzed using linear regression adjusted for baseline variables. Secondary outcomes included change in vasopressor requirements, hemodynamic changes, and postoperative outcomes. Fifty-eight patients were included (Oxiris = 30; control = 28), and cardiac transplantation was the most common type of surgery. The Oxiris group had a higher VIS at baseline (113 ± 21 v 101 ± 19, p = 0.020). The Oxiris group showed a significantly greater reduction in VIS compared to controls, with a mean difference of -18.9 (95% CI, -37.3 to -0.4; p = 0.045). This change was primarily driven by reduced norepinephrine doses, with a mean group difference of -0.19 µg/kg/min (95% CI, -0.35 to -0.03; p = 0.019). There were no significant differences in hemodynamic parameters, fluid balance, intensive care unit stay, or 30-day mortality.
CONCLUSIONS: Oxiris filter therapy was associated with a significantly greater reduction in vasoactive inotropic support compared to standard CRRT filters in patients with vasoplegia following cardiac surgery.