Endotoxin Elimination in Patients with Septic Shock: An Observation Study

Adamik, Barbara; Zieliński, Stanisław; Śmiechowicz, Jakub; Kübler, Andrzej

doi:10.1007/s00005-015-0348-8

Cited by 45 publications

(36 citation statements)

References 29 publications

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“…The peptide covers the surface of a porous polyethylene matrix designed to provide an optimal binding surface. A few case series in critically ill adults have reported a decrease in endotoxin levels and a hemodynamic improvement [18][19][20]. However, the ASSET (abdominal septic shock -endotoxin adsorption treatment) multicenter RCT evaluating the feasibility of Alteco ® LPS adsorber was terminated early because of patient recruitment issues [21].…”

Section: Removing Endotoxinsmentioning

confidence: 99%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

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Section: Removing Endotoxinsmentioning

confidence: 99%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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“…Evidence for LPS adsorbers was obtained from case reports/series [ 60 – 62 ] that showed a decrease in endotoxin level as well as improvement in patient hemodynamics with no significant side effects. A feasibility study (The ASSET trial) was unfortunately terminated early due to difficulty recruiting patients (NCT02335723).…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

et al. 2018

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Sepsis is one of the leading causes of morbidity and mortality worldwide. It is characterized by a dysregulated immune response to infections that results in life-threatening organ dysfunction and even death. Bacterial cell wall components (endotoxin or lipopolysaccharide), known as pathogen-associated molecular patterns (PAMPs), as well as damage-associated molecular patterns (DAMPs) released by host injured cells, are well-recognized triggers resulting in the elevation of both pro-inflammatory and anti-inflammatory cytokines. Understanding this complex pathophysiology has led to the development of therapeutic strategies aimed at restoring a balanced immune response by eliminating/deactivating these inflammatory mediators. Different extracorporeal techniques have been studied in recent years in the hope of maximizing the effect of renal replacement therapy in modulating the exaggerated host inflammatory response, including the use of high volume hemofiltration (HVHF), high cut-off (HCO) membranes, adsorption alone, and coupled plasma filtration adsorption (CPFA). These strategies are not widely utilized in practice, depending on resources and local expertise. The literature examining their use in septic patients is growing, but the evidence to support their use at this stage is considered of low level. Our aim is to provide a comprehensive overview of the technical aspects, clinical applications, and associated side effects of these techniques.

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“…Septic shock is a disease caused by infection, with abnormal blood distribution as the main feature, and with the hypoxic ischemic tissues and organs as the major pathophysiological changes ( 1 – 3 ). The gastrointestinal hypoxia remains after the blood pressure is corrected.…”

Section: Introductionmentioning

confidence: 99%

Effects of dopamine, norepinephrine and dobutamine on gastric mucosal pH of septic shock patients

Zhang

et al. 2016

Experimental and Therapeutic Medicine

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The effect of different vasoactive drugs on the pH [intracellular pH (pHi)] of gastric mucosa in patients with septic shock was evaluated in the present study. According to the vasoactive drugs applied, 48 patients with septic shock were divided into 3 groups: A, B and C, with 16 cases each. Cases of group A were treated with dopamine, those of group B with norepinephrine while those of group C were treated with norepinephrine plus dobutamine. The changes of pH of gastric mucosa were observed before treatment (baseline) and 6, 12, 24 and 48 h after treatment, and the hemodynamic indicators were observed before treatment (baseline) and 6 h after administration. The gastric mucosal pH was not significantly different between two of the three groups before treatment (each at P>0.05). The gastric mucosal pH of group A did not change 6, 12, 24 and 48 h after treatment with drugs compared with the baseline (all at P>0.05), while the gastric mucosal pH in groups B and C were each statistically higher at the time points of 6, 12, 24 and 48 h after treatment with drugs compared with the respective baselines (all at P<0.05). Following treatment with drugs, the gastric mucosal pH of group C at all the time points of 6, 12, 24 and 48 h after treatment were significantly higher than those of groups A and B at the same time points after treatment, while there were some statistical differences between groups A and B at these time points (6, 12, 24 and 48 h after treatment; P<0.05). The hemodynamic indicators of the patients before treatment were not significantly different between two of the three groups (all at P>0.05). Compared with the baseline values, the mean arterial pressure and the cardiac index of each group after treatment were significantly increased, the pulmonary capillary wedge pressure and the central venous pressure of groups B and C significantly increased (all at P<0.05) and the heart rate of group A was significantly increased (P<0.05). In conclusion, the gastric mucosal pH of the septic shock patients was increased when treated with norepinephrine or with dobutamine. Additionally, the gastric mucosal pH was significantly higher when the patients were treated with dobutamine and norepinephrine in combination than with norepinephrine or dopamine alone. Dopamine, norepinephrine and dobutamine can improve the systemic hemodynamic conditions in patients with septic shock.

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Endotoxin Elimination in Patients with Septic Shock: An Observation Study

Cited by 45 publications

References 29 publications

Extracorporeal Blood Purification Therapies for Sepsis

Extracorporeal Blood Purification Therapies for Sepsis

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

Effects of dopamine, norepinephrine and dobutamine on gastric mucosal pH of septic shock patients

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