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Войти в исследования Critical care explorations · 2026
Drug Clearance and Dosing During CytoSorb Hemoadsorption: A Systematic Review.
Систематический обзорСтатьяНазвание и аннотация: Перевод в очереди
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Klaus Teresa, Honoré Patrick M, Bottari Gabriella, De Rosa Silvia, Kindgen-Milles Detlef, Schneider Antoine, Marczin Nandor, Adamson Harriet, Scheier Joerg, Deliargyris Efthymios N, Nolin Thomas D
Аннотация
OBJECTIVE: CytoSorb (CS) hemoadsorption is increasingly used in critical care and cardiac surgery to remove inflammatory mediators and select drugs. This systematic review aimed to summarize available evidence on intentional drug removal as well as unintentional drug removal during CS therapy.
DATA SOURCES: PubMed, congress abstracts, and CytoSorbents online literature database.
STUDY SELECTION: Eligible studies included benchtop, animal, and human pharmacokinetic investigations of drug removal during CS therapy as well as clinical reports describing CS use for drug overdose.
DATA EXTRACTION: Data from the eligible studies were extracted independently by two authors into Microsoft Excel.
DATA SYNTHESIS: Data were identified for drugs across multiple therapeutic classes, including analgesics, antiarrhythmics, anticonvulsants, antidepressants, antihypertensives, anti-infectives, antithrombotics, anxiolytics, and immunosuppressants. Drugs were categorized into low (< 30%), moderate (30-60%), or high (> 60%) removal rate, or by the relative increase in clearance attributable to CS: negligible (< 25%), low (25-100%), moderate (100-400%), or high (> 400%). Based on the assembled data and considering drug-, patient-, and circuit-specific factors, general dosing recommendations for concomitant medications were developed.
CONCLUSIONS: CS therapy can alter drug concentrations for select agents with variable clinical relevance. CS can reduce perioperative bleeding risk through antithrombotic removal and treat certain drug overdoses. Unintentional drug removal during CS therapy may occur and practical guidance is provided for drugs with known susceptibility to removal.
DATA SOURCES: PubMed, congress abstracts, and CytoSorbents online literature database.
STUDY SELECTION: Eligible studies included benchtop, animal, and human pharmacokinetic investigations of drug removal during CS therapy as well as clinical reports describing CS use for drug overdose.
DATA EXTRACTION: Data from the eligible studies were extracted independently by two authors into Microsoft Excel.
DATA SYNTHESIS: Data were identified for drugs across multiple therapeutic classes, including analgesics, antiarrhythmics, anticonvulsants, antidepressants, antihypertensives, anti-infectives, antithrombotics, anxiolytics, and immunosuppressants. Drugs were categorized into low (< 30%), moderate (30-60%), or high (> 60%) removal rate, or by the relative increase in clearance attributable to CS: negligible (< 25%), low (25-100%), moderate (100-400%), or high (> 400%). Based on the assembled data and considering drug-, patient-, and circuit-specific factors, general dosing recommendations for concomitant medications were developed.
CONCLUSIONS: CS therapy can alter drug concentrations for select agents with variable clinical relevance. CS can reduce perioperative bleeding risk through antithrombotic removal and treat certain drug overdoses. Unintentional drug removal during CS therapy may occur and practical guidance is provided for drugs with known susceptibility to removal.