Use of CytoSorb® as a therapeutic option in a critically ill patient with acute respiratory distress syndrome caused by influenza A (H1N1) pneumonia: A case report.

ABSTRACT

Acute respiratory distress syndrome is an acute inflammatory lung process, which leads to protein-rich nonhydrostatic pulmonary edema, refractory hypoxemia, and lung "stiffness". There are a number of therapies that are currently being investigated in the treatment of sepsis; one of the most promising treatment options at this moment is cytokine removal by hemoperfusion (CytoSorb®). We present the case of a 29-year-old male patient who was admitted to the Medical Intensive Care Unit in a state of multiple organ dysfunction and massive bilateral pneumonia caused by influenza type A. The patient was healthy before hospital admission. Due to acute respiratory failure and altered state of consciousness, the patient was intubated using analgosedation and connected to a controlled mechanical ventilation mode immediately after admission. The initial computed tomography scan showed massive bilateral pneumonia, and few days later, the patient's condition progressively worsened and he developed signs of multiorgan failure. Given the patient's progressing hemodynamic instability and uncontrolled inflammatory response, a CytoSorb® adsorber was added into the continuous renal replacement therapy circuit. The combination of pharmacotherapy, supportive measures, and application of CytoSorb® resulted with complete recovery of the patient (hemodynamic stability improved as evidenced by decreased vasopressor requirements).