Plasmapheresis combined with continuous venovenous hemofiltration in surgical patients with sepsis

Abstract

Reduction in mortality in single- and double-organ failure was as high as 28% in septic patients with combined extracorporeal detoxification. A prospective randomized trial in sepsis and double-organ failure should be projected.

Short-term cardiovascular effects of plasmapheresis in norepinephrine-refractory septic shock

“…Pathophysiologically, plasmapheresis should interrupt the so-called "vicious circle" of the systemic inflammatory response with subsequent refractory septic shock by removing virtually all mediators from the blood [2,3,4]. However, published data of patients with sepsis or septic shock treated with plasmapheresis report either an increase [1,2,3,4] or no change [5,6] in survival rate, and until today no randomized controlled doubleblinded trial of plasmapheresis in an a priori defined homogeneous patient group such as patients with sepsis or (norepinephrine-refractory) septic shock is available. That (even repeated or continuous) plasmaphereses yielded conflicting results with regard to an improved outcome might be explained by several factors.…”

“…Plasmapheresis has been proposed as a rescue treatment in refractory septic shock [1,2,3,4,5,6]. The majority of these studies report improved outcome, possibly associated with plasmapheresis, compared to historical or no controls [1,2,3,4].…”

Plasma exchange as rescue therapy in multiple organ failure including acute renal failure*

“…In a larger randomized study by Busund et al (43), a significantly favorable survival using plasma exchange was found. In another controlled study including 43 patients, performed by Schmidt et al (44), plasma exchange was combined with continuous venovenous hemofiltration in surgical patients with sepsis. In that study, there was a significant reduction in mortality of patients with a more extensive degree of disease, whereas this difference was not significant when including patients with less severe illness.…”

Effect of Plasmapheresis on the Immune System in Endotoxin-Induced Sepsis

“…Of the prospective studies in which the benefit of plasma filtration has been compared with retrospective controls, two studies have shown a beneficial effect in meningococcal sepsis whereas a third study including patients with severe sepsis failed to show a difference in survival [19] .…”