The first experience of using a device for selective hemosorption of lipopolysaccharide “Toxipak 300” in the treatment of patients with septic shock

Objective. To evaluate the clinical and laboratory efficacy, safety and ease of use of the device for LPS adsorption “Toxipak 300” in the treatment of patients with septic shock. Material and methods. The study included 5 patients with septic shock and a high level of endotoxin activity (EAA >0.6) in the blood who were treated at the clinics of the Military Medical Academy. All patients included in the study underwent from 1 to 2 operations of LPS adsorption. The effectiveness of LPS adsorption operations was evaluated by studying the dynamics of blood pressure, the dose of vasopressor support, the vasopressor dependence index (VDI), the severity of organ dysfunction on the SOFA, the level of EAA in the blood, the functional state of neutrophils, laboratory indicators of systemic inflammation, endogenous intoxication, tissue perfusion. Results. A day after LPS adsorption, there was a statistically significant decrease in the dose of vasopressor support with norepinephrine (p=0.026) and VDI (p=0.028). In three of the seven cases of LPS adsorption, septic shock was stopped during the following days. In three other cases, there was a significant decrease in the required dose of norepinephrine and VDI. In one case, an increase in these indicators was noted. There were no significant changes in the values of laboratory parameters reflecting the severity of endotoxinemia, systemic inflammatory response and tissue perfusion disorders. When studying the safety of using the “Toxipak 300” LPS adsorption device, it was found that no severe complications and clinically significant adverse events were detected during its operation. Conclusion. LPS adsorption using the “Toxipak 300” device is safe enough, it is not accompanied by the development of severe complications and clinically significant adverse events. The presence, in most cases, of positive changes in the clinical parameters of central hemodynamics in patients with septic shock against the background of the absence of significant improvements in laboratory parameters of endotoxinemia, systemic inflammatory response and tissue perfusion disorders, along with a small number of patients included in the study, require additional clinical and experimental studies aimed at determining the effectiveness of this device.