Coupled plasma filtration and adsorption in septic shock: a multicentric experience

Clinical use of plasmafiltration coupled with adsorption

“…[17] Of course, when interpreting the preclinical findings, we must take into account the main differences between the experimental model and human sepsis, because the observation of septic shock shows that the use of CPFA is related to the improvement of various clinical variables, such as the use of mean blood pressure (MAP) and vasopressin, [18][19][20][21][22] and the improvement of cardiac index and PaO2/FiO2. [23] However, all these variables tend to return to baseline during the intervals between treatments, indicating that the benefits disappear at the end of each therapy. This "saw-tooth" trend has been replicated in clinical studies with CPFA, in which the sublingual microcirculation has been analyzed by using orthogonal polarization spectral imaging [24] and suggests that clearance of inflammatory mediators is much more efficient than hemofiltration or plasma alone, but that this effect may not necessarily be associated with a change in mortality.…”

“…[40] The use of CPFA has shown a good effect in patients with ARDS, improving the commitment of PaO2/FiO2 and lung parenchyma. [23,41] As previously described, there is no evidence to support the use of CPFA in septic shock to reduce mortality, but studies prior to clinical trials documented the possibility of benefits at other levels not as compelling as mortality, such as increasing MAP, decreasing inotropic support, and improving oxygenation. (18)(19)(20)(21)(22)(23) On the other hand, we know that the benefits of CPFA depend on reaching a certain amount of therapeutic plasma, and have nothing to do with the time after the onset of hypotension.…”

“…[23,41] As previously described, there is no evidence to support the use of CPFA in septic shock to reduce mortality, but studies prior to clinical trials documented the possibility of benefits at other levels not as compelling as mortality, such as increasing MAP, decreasing inotropic support, and improving oxygenation. (18)(19)(20)(21)(22)(23) On the other hand, we know that the benefits of CPFA depend on reaching a certain amount of therapeutic plasma, and have nothing to do with the time after the onset of hypotension. [29] In view of these facts, it is necessary to consider new situations in which CPFA may be beneficial to patients with septic shock.…”

Recent Advances in Extracorporeal Therapies

“…22 Fifty-five septic patients were enrolled in an Italian multi-centric study. 23 Every patient had four CPFA treatments. The investigators evaluated hemodynamic parameters, norepinephrine dosage, PaO2/FiO2 ratio, plasma IL-6, and procalcitonin (PCT).…”