A pilot study of coupled plasma filtration with adsorption in septic shock*

Abstract

In patients with septic shock, coupled plasmafiltration-adsorption combined with hemodialysis was associated with improved hemodynamics compared with continuous venovenous hemodiafiltration. This result might be related to its ability to restore leukocyte responsiveness to lipopolysaccharide. These findings suggest a potential role for blood purification in the treatment of septic shock.

Prevention and Treatment of Acute Renal Failure in Sepsis

“…BP was higher and norepinephrine requirements were lower during CPFA. Although plasma TNF-␣ and interleukin-10 levels did not change during either treatment, ex vivo spontaneous and LPS-induced TNF-␣ production from patients whole blood increased over time with CPFA (133).…”

“…CPFA improved survival in a rabbit model of endotoxic shock (132). Ten patients with hyperdynamic septic shock were treated with 10-h CPFA or CVVH in random order (133). BP was higher and norepinephrine requirements were lower during CPFA.…”

“…The respective roles of inflammatory mediators and counter-regulatory antiinflammatory systems and their dynamics during the course of sepsis are insufficiently clarified. It appears non-sequitur to restore the endogenous TNF-␣ production by leukocytes with CPFA (133) in the same patients who may be considered for treatment with anti-TNF-␣ molecules (41). In addition, any attempt to substantially increase nonspecific mediator removal will almost certainly deplete valuable nutrients, albumin, hormones, vitamins, trace elements, and antibiotics, with potential detrimental effects for the patient.…”

Clinical review: Blood purification for sepsis

“…Several studies have demonstrated the safety and the effectiveness of CPFA for removing inflammatory mediators from the circulation [60,61]. Moreover, CPFA was able to increase the survival of a rabbit model of endotoxic shock and to improve hemodynamics and the pulmonary function of patients with septic shock [62,63].…”

“…In pigs with hyperdynamic septic shock, continuous hemofiltration, unlike CPFA, was able to remove some inflammatory mediators involved in delayed cardiac repolarization [65]. Conversely, Ronco and colleagues [61] reported in patients with septic shock that CPFA combined with hemodialysis was associated with greater improved hemodynamics compared with continuous hemodiafiltration. The authors hypothesized that this result could be due to the ability of CPFA to restore leukocyte responsiveness to lipopolysaccharide.…”