Meet the Expert 5

How Do I Use Hemoadsorption in My Practice?

Session Overview

Hemoadsorption has emerged as a potential adjunctive therapy for selected critically ill patients with severe inflammatory dysregulation. However, its clinical value depends heavily on appropriate patient selection, timely initiation, technical optimization, and careful assessment of treatment response.

This session will examine a patient with fecal peritonitis caused by colon perforation who developed refractory postoperative septic shock despite surgical source control and broad-spectrum antibiotics. In the presence of high vasopressor requirements, elevated lactate, severe AKI, and markedly increased procalcitonin, continuous venovenous hemodiafiltration (CVVHDF) with oXiris was initiated to target endotoxin and cytokine removal.

What Will Be Covered

• Patient selection for hemoadsorption in septic shock
• Appropriate timing of treatment initiation
• Contraindications and situations in which hemoadsorption is unlikely to be beneficial
• Selection and optimization of blood flow, effluent dose, and treatment modality
• Anticoagulation strategies and prevention of circuit clotting
• Cartridge change and treatment duration
• Clinical and laboratory parameters for monitoring treatment response
• Criteria for stopping therapy
• Indications for re-initiation after initial discontinuation
• Integration of hemoadsorption with source control, antibiotics, and standard sepsis care

What Participants Will Learn

Participants will learn how to identify patients who may benefit from hemoadsorption, prescribe the therapy safely, and troubleshoot common technical problems. The session will also emphasize how to evaluate therapeutic response and avoid prolonged or repeated treatment without a clearly defined clinical objective.

Target Audience

Intensivists, nephrologists, emergency physicians, surgeons, fellows, residents, critical care nurses, dialysis nurses, and other healthcare professionals involved in the care of patients with septic shock and extracorporeal organ support.

Hemoadsorption 的臨床實務應用

課程簡介

Hemoadsorption 近年逐漸被應用於部分具有嚴重發炎失衡的重症病人，但其臨床效益高度取決於病人選擇、治療時機、技術設定，以及是否能持續而有系統地評估治療反應。

本場次將討論一名因大腸穿孔引發糞便性腹膜炎的病人。病人雖已接受手術控制感染源及廣效抗生素治療，術後仍出現頑固性 septic shock，合併高劑量升壓劑需求、lactate 上升、嚴重 AKI 及 procalcitonin 顯著升高，因此開始接受 CVVHDF 合併 oXiris，以期移除 endotoxin 與 inflammatory mediators。

課程內容

• Septic shock 病人使用 hemoadsorption 的選擇條件
• 治療開始的適當時機
• Contraindications，以及較不可能從治療中獲益的情境
• Blood flow、effluent dose 與治療模式的設定與調整
• Anticoagulation 策略及 circuit clotting 的預防
• Cartridge 更換時機與治療期間
• 評估治療反應的臨床與實驗室指標
• 停止治療的判斷標準
• 初次停用後再次啟動治療的考量
• Hemoadsorption 與感染源控制、抗生素及標準 sepsis 治療的整合

參與者將學到

參與者將學習如何選擇可能從 hemoadsorption 獲益的病人、規劃安全的治療處方，並處理 circuit clotting、抗凝與 cartridge 更換等常見技術問題。

課程亦將強調，hemoadsorption 應有明確的治療目標與評估方式，避免在缺乏臨床反應的情況下持續或反覆使用。

適合對象

重症醫學科、腎臟科、急診醫學科及外科醫師、研究醫師、住院醫師、重症護理師、透析護理師，以及參與 septic shock 與 extracorporeal organ support 照護的醫療專業人員。