Adjunctive therapy of severe sepsis and septic shock in adults

Andersen, TO; Jensen, Thomas; Andersen, LW

doi:10.1016/j.cacc.2009.07.006

Cited by 4 publications

(4 citation statements)

References 39 publications

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“…Data available confirmed an effective reduction in the LPS level in the patients' blood after this procedure (Yaroustovsky M, 2009, Andersen T.H., 2009). In particular, Kulabukhov VV et al demonstrated almost total elimination of LPS from the patient's blood (from 1.44 EU/ml before treatment to 0.03 EU/ml post treatment) (Kulabukhov VV., 2008).…”

Section: Immunological Pathogenesis Of Septic Reactions and Eliminatimentioning

confidence: 66%

Immunological Pathogenesis of Septic Reactions and Elimination of Triggers and Mediators of Inflammation

Shubina¹,

Anisimova²,

Громова³

et al. 2012

Insight and Control of Infectious Disease in Global Scenario

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Section: Immunological Pathogenesis Of Septic Reactions and Eliminatimentioning

confidence: 66%

Immunological Pathogenesis of Septic Reactions and Elimination of Triggers and Mediators of Inflammation

Shubina¹,

Anisimova²,

Громова³

et al. 2012

Insight and Control of Infectious Disease in Global Scenario

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“…Although many trials targeting inhibition of inflammatory mediators have failed to show any reduction in mortality and to date, only corticosteroids and drotrecogin alfa have been able to modulate inflammatory response and demonstrated mortality benefits. [ 26 ] Researchers have shown a decrease in tumor necrosis factor alpha (TNF-α), IL-1β, IL-6, inducible nitric oxide synthase, and prostaglandin E2 with VP use indicating an anti-inflammatory property for this drug. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

Vasopressin in septic shock; assessment of sepsis biomarkers: A randomized, controlled trial

Barzegar

Nouri

Mousavi

et al. 2017

Indian Journal of Critical Care Medicine

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Background and Aims:Vasopressin (VP) in sepsis apart from vasoconstrictive effect may have some immunomodulatory effects. The aim of this study was to evaluate the effect of VP on different aspect of sepsis by measuring of sepsis biomarkers.Materials and Methods:In this trial, a total number of 42 septic shock patients were included. The first group received norepinephrine (NE) infusion to reach the target mean arterial pressure (MAP) of ≥ 65 mm Hg and the second group received arginine vasopressin (AVP) infusion in addition to NE. Serum lactate, C-reactive protein (CRP), interleukin-6 (IL-6), IL-10, pentraxin 3 (PTX3), angiopoietin 1 and 2 (Ang 1 and 2) levels were assessed.Results:Level of IL-6 and IL-10 decreased, but there was no significant difference between the two groups after 48 h. CRP and PTX3 levels were not also significantly different between groups. Although Angs were not statistically different, there was a trend toward higher Ang-1 in and lower Ang 2 in AVP group after 24 and 48 h. In addition, lactate level did not differ between NE and AVP groups. There was no interaction between VP and hydrocortisone use on IL-6, IL-10, and PTX3, but a significant statistical interaction on Ang 1 and Ang 2 were observed.Conclusions:Although analysis of sepsis biomarkers showed no significant difference between two groups, no immunomodulatory effect for VP alone, subgroup analysis of hydrocortisone used in this study showed that the combination of glucocorticoids and AVP had a significant effect on Angs level which eventually causes less endothelial permeability and higher MAP in this group of patients.

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“…Newer haemofiltration techniques have been proposed to moderate the inflammatory cascade as well as providing endotoxin adsorption, as a rationale for modifying the biological cascade in Gram-negative sepsis cases [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Human trials have confirmed the positive effect on the parameters of the patients’ haemodynamics and reduction of inflammatory cytokines, but not on the morbidity or survival which were attributed to the heterogeneity of patients suffering from the consequences of severe infectious diseases and sepsis [ 6 ]. Several studies have demonstrated efficient endotoxin removal with the Polymyxin B – immobilised fibre column, as well as the suppression of Staphylococcus aureus lipoteichoic acid, induced TNF-α production [ 7 , 8 , 9 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Case Report. The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report

Hadade

Breazu

Ilie

et al. 2017

The Journal of Critical Care Medicine

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Sepsis and septic shock are major healthcare problems, resulting in high morbidity and mortality. The Surviving Sepsis Campaign (SSC), which standardised the approach to sepsis, was recently updated. Strategies to decrease the systemic inflammatory response have been proposed to modulate organ dysfunctions. Endotoxin, derived from the membrane of Gram-negative bacteria, is considered a major factor in the pathogenesis of sepsis. Endotoxin adsorption, if effective, has the potential to reduce the biological cascade of Gram-negative sepsis.We present a case of a 64-year-old man with severe Gram-negative sepsis, following purulent peritonitis secondary to rectosigmoid adenocarcinoma. To reduce the amplitude of the general effects of endotoxins we used a novel device, the Alteco® LPS Adsorber (Alteco Medical AB, Lund, Sweden), for lipopolysaccharide (LPS) adsorption.The efficacy markers were: the overall haemodynamic profile, translated into decreased vasopressor requirements, the normalisation of the cardiac index, the systemic vascular resistance index combined with the lactate level and the reduction in procalcitonin (PCT) levels. A decrease in the sequential organ failure assessment (SOFA) score at twenty-four hours was demonstrated.The clinical course following treatment was favourable for the days immediately following the treatment.This was attributed to the removal of endotoxin from the systemic circulation. The patient died one week after the endotoxin removal session, developing an ischemic bowel perforation with subsequent multiple organ failures.

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Adjunctive therapy of severe sepsis and septic shock in adults

Cited by 4 publications

References 39 publications

Immunological Pathogenesis of Septic Reactions and Elimination of Triggers and Mediators of Inflammation

Immunological Pathogenesis of Septic Reactions and Elimination of Triggers and Mediators of Inflammation

Vasopressin in septic shock; assessment of sepsis biomarkers: A randomized, controlled trial

Case Report. The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report

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