Blood Purification and Mortality in Sepsis

Zhou, Feihu; Peng, Zhiyong; Murugan, Raghavan; Kellum, John A.

doi:10.1097/ccm.0b013e31828cf412

Cited by 156 publications

(60 citation statements)

References 48 publications

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“…A 2013 meta-analysis of 16 trials concluded that blood purification decreased mortality in sepsis compared to no blood purification. However, these results were driven mainly by hemoperfusion and plasma exchange, and pooling of all trials of blood purification for treatment of sepsis was no longer associated with lower mortality after excluding trials using polymyxin B hemoperfusion [88]. There is also a negative study pending publication using polymyxin B hemoperfusion presented at ESICM LIVES 2016 [89].…”

Section: Determine the Efficacy Of "Blood Purification" Therapies Sucmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: Determine the Efficacy Of "Blood Purification" Therapies Sucmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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“…An extensive research of the literature identified 16 clinical trials, including those evaluating hemofiltration, hemoperfusion and plasma exchange techniques. Blood purification was able to reduce the mortality of septic patients, although this result was mainly driven by polymyxin B-based studies, thus confirming its relevant role in changing the course of septic disease [21]. …”

Section: Ongoing Trials and Future Directionsmentioning

confidence: 99%

Endotoxin Removal: History of a Mission

Ronco

2014

Blood Purif

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One of the key molecules involved in the pathogenesis of severe sepsis and septic shock is lipopolysaccharide (LPS) or endotoxin, which is a component of the cellular wall of Gram-negative bacteria. Clinical studies have shown that the level of circulating LPS is correlated with illness severity (APACHE II), the onset and amount of organ dysfunction (SOFA) and intensive care unit mortality. Many therapeutic strategies have attempted to neutralize the pathogenic activity of endotoxin in order to interrupt the progression of a septic state towards a worsened clinical framework, i.e. severe sepsis of septic shock. Over the past decades the role of extracorporeal hemoperfusion by means of polymyxin B-based cartridges (PMX-DHP) to bind and neutralize LPS from whole blood has increased in clinical relevance. This is due to an increasing number of studies confirming that a directed therapy of endotoxic shock could significantly influence the course of the septic cascade. This review will outline the meaning of the targeted approach to endotoxin, both highlighting the specific immunologic effect of endotoxin removal by polymyxin B and the evidence of clinical improvements following this kind of therapy in terms of recovery of organ function.

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“…These results are mainly influenced by studies using polymyxin B hemoperfusion from Japan [24]. Removing endotoxin would be an effective approach in the management of severe sepsis and in refractory septic shock.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

“…These devices have also been successfully used in patients with sepsis due to Gram-positive microorganisms and in patients with acute respiratory distress syndrome, suggesting that they could have an immunomodulating action in addition to endotoxin elimination [25,26,27]. The impact of blood purification on survival was not attenuated in subgroups with lower risk of death, indicating the need for future trials of early blood purification to prevent the progression of sepsis disease [24]. …”

Section: Therapeutic Strategiesmentioning

confidence: 99%

State of the Art in the Clinical Treatment of Endotoxic Shock

Artigas

Piccinni

2014

Blood Purif

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Sepsis is a major health problem and remains an important cause of death worldwide. The failure to convert advances in our understanding of the biologic features of sepsis into effective new therapies questions the current approach to the development of sepsis drugs, and suggests a need for newer and better clinical trial design. Blood purification for sepsis is a promising therapeutic strategy to improve survival and reduce organ failure in patients with severe sepsis and septic shock.

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Blood Purification and Mortality in Sepsis

Cited by 156 publications

References 48 publications

Surviving sepsis campaign: research priorities for sepsis and septic shock

Surviving sepsis campaign: research priorities for sepsis and septic shock

Endotoxin Removal: History of a Mission

State of the Art in the Clinical Treatment of Endotoxic Shock

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