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However, this approach does not seem to be based on robust evidence, and it does not follow international guidelines. To understand the pathophysiological rationale and timing of HA, we conducted a large animal septic shock experiment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Design<\/jats:title>\n                <jats:p>Prospective randomized large-animal peritoneal septic shock experiment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Setting<\/jats:title>\n                <jats:p>Laboratory investigation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Subjects<\/jats:title>\n                <jats:p>Twenty-six anesthetized, mechanically ventilated, and instrumented pigs randomly assigned into (1) sham-operated group with HA (SHAM, <jats:italic>n<\/jats:italic>\u2009=\u20095); (2) sepsis animals without HA (SEPSIS, <jats:italic>n<\/jats:italic>\u2009=\u20095); (3) sepsis group with HA at norepinephrine initiation (EARLY, <jats:italic>n<\/jats:italic>\u2009=\u20098); and (4) sepsis group with HA initiated at norepinephrine rate reaching 0.5 \u03bcg\/kg\/min (LATE, n\u2009=\u2009<jats:italic>8<\/jats:italic>).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Interventions<\/jats:title>\n                <jats:p>Peritoneal sepsis was induced by cultivated autologous feces inoculation. A CytoSorb cartridge (200 g) with a blood flow rate of 200 mL\/min and heparin anticoagulation was used to perform HA. The animals received sedation and intensive organ support up to 48 h or until they experienced cardiovascular collapse.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Measurements and main results<\/jats:title>\n                <jats:p>Systemic hemodynamics, multiple-organ functions, and immune-inflammatory response were measured at predefined periods. The HA treatment was not associated with any measurable benefit in terms of systemic hemodynamics and organ support. The systemic inflammatory markers were unaffected by any of the treatment timings. In contrast, the HA resulted in higher vasopressor load and decreased 36-h survival (5 animals in SHAM (100%), 4 (80%) in SEPSIS, 4 (57%) in EARLY, and 2 (25%) in LATE; <jats:italic>p<\/jats:italic>\u2009=\u20090.041). The HA exposure in healthy animals was associated with hemodynamic deterioration, systemic inflammatory response, and cytopenia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In this large-animal-controlled fulminant sepsis study, the HA was unable to counteract the disease progression in the early or advanced septic shock phase. However, findings from the HA-exposed sham animals suggest potential safety concerns.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40635-024-00622-x","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T12:01:58Z","timestamp":1713441718000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ineffectiveness of hemoadsorption in large animals with abdominal sepsis: a randomized controlled porcine study"],"prefix":"10.1186","volume":"12","author":[{"given":"Vaclav","family":"Tegl","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Horak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Nalos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michala","family":"Horakova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milan","family":"Stengl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Matejovic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9783-9683","authenticated-orcid":false,"given":"Jan","family":"Benes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"key":"622_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13054-020-02950-2","volume":"24","author":"M Bauer","year":"2020","unstructured":"Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D (2020) Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019\u2014results from a systematic review and meta-analysis. 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