The Use of a Cytokine Adsorber (CytoSorb) in a Patient with Septic Shock and Multi-Organ Dysfunction (MODS) after a Severe Burn Injury.

Case presentation • Affected were both arms, face, thorax as well as both thighs • Pre-existing diseases included known epilepsy and multifactorial drug abuse • The ABSI score (abbreviated burn severity index) was 10 points • On admission, immediate bath therapy was performed while the patient was still circulatory and hemodynamically stable, with a complete body shave/washing and surgical wound cleaning of the burned areas • No trauma requiring surgical treatment was detected in the emergency trauma CT • Bronchoscopy confirmed inhalation trauma grade II • As a result of burns grade III, escharotomy was performed on both arms and thorax on the day of admission • Multiple operations were carried out and later, also Meek-transplantations 1: 6 on the lower abdomen, both upper arms, the upper thorax and both forearms • Furthermore, residual necrotic tissue was removed predominantly from the back and face, using epifascial debridements • There was a pronounced loss of transplant, as a result cultured keratinocytes (which were obtained early in advance) were used for restoration • Due to the confirmed inhalation trauma grade II, a Rotorest bedding with dorso-ventral alternating bedding was carried out and an adaptation of the ventilation parameters was performed • Due to persistently elevated inflammatory (leukocytes, C-reactive protein [CRP] and procalcitonin) and renal function parameters, positive blood cultures and wound smears confirming Acinetobacter baumannii 4MRGN [multiresistant gram-negative pathogen], hemofiltration therapy with additional integration of a CytoSorb adsorber was commenced