Continuous plasmafiltration in sepsis syndrome

Reeves, John H.; Butt, Warwick; Shann, Frank; Layton, Judith E.; Stewart, Alastair G.; Waring, Paul; Presneill, Jeffrey

doi:10.1097/00003246-199910000-00003

Cited by 203 publications

(83 citation statements)

References 52 publications

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“…Nevertheless, it has been suggested that these therapies might be beneficial, especially for patients with Gram-negative sepsis [52,54,56,57] and when implemented as early as possible [58]. Additional studies are therefore warranted to better assess these therapies for blood purification [59].…”

Section: Plasmapheresis and Coupled Plasma Filtration Adsorptionmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

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Section: Plasmapheresis and Coupled Plasma Filtration Adsorptionmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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“…Current guidelines, for example, state that 'hemofiltration should not be used in patients with sepsis without renal indications unless ongoing studies provide positive results' [24]. The role of plasma exchange remains equally controversial [25,26]. In contrast, the initial findings with CPFA are consistent and provide provocative observations, which will no doubt encourage clinical investigators to further pursue the path of blood purification.…”

Section: Resultsmentioning

confidence: 99%

Coupled Plasma Filtration Adsorption: Rationale, Technical Development and Early Clinical Experience

et al. 2003

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The adjuvant treatment of sepsis remains a major therapeutic challenge. Blood purification is theoretically appealing if the humoral theory of sepsis is accepted as the basis for intervention. In this setting, blood purification would provide a broad-based restoration of humoral homeostasis thereby avoiding both excessive inflammation and counterinflammation. Several techniques of blood purification have been tried or are under active investigation. One of these is the so-called coupled plasma filtration adsorption (CPFA). CPFA is a novel extracorporeal blood purification therapy aimed at nonselectively reducing the circulating levels and activities of both pro- and anti-inflammatory mediators during sepsis and multiorgan failure. In vitro studies have shown CPFA to be effective in binding a broad range of such mediators proving its technical efficacy. Subsequent animal models have shown a beneficial effect on survival in endotoxemia. These studies have provided the necessary technical developments and biologic rationale for initial human studies. Two phase I/IIa clinical studies have now been performed. Both studies have shown that CPFA improves blood pressure and restores immune function in patients with severe sepsis and multiorgan dysfunction. In this article, we will discuss some of the basic principles involved in sorbent technology, and how these may contribute to treatment efficacy, review animal experiments with CPFA and finally discuss the results of recent human studies and their implications.

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“…One randomized controlled trial of a limited number of subjects revealed a trend toward fewer failing organs but no effect on mortality with continuous plasmapheresis using a hollow-fiber plasma filter [14]. Another randomized clinical trial of 106 patients with septic shock found an all-cause mortality rate of 33.3% in the continuous flow plasmapheresis group and 53.8% in the control group, but imbalances in randomization favored the pheresis group [15].…”

Section: Increased Membrane Permeabilitymentioning

confidence: 99%

Emerging Therapies for Extracorporeal Support

2008

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Dialytic therapies have undergone major technological developments in the last decade and emerging techniques are promoted not only for acute kidney injury, but also for sepsis, acute decompensated heart failure, and acute and acute-on-chronic liver failure. New devices specifically target the pathophysiological mechanisms involved in these conditions. In septic shock and sepsis, high-volume hemofiltration, coupled plasma filtration adsorption, cascade hemofiltration and high permeability hemofiltration enhance removal of pro-inflammatory mediators, while in liver failure, Molecular Adsorbents recycling System (MARS®) and Prometheus® favor the elimination of albumin-bound toxins such as bilirubin. In acute decompensated heart failure, simplified ultrafiltration machines are used to reach negative fluid balance in a minimalist setting. In the context of limited resources and growing expansion in the availability of technologies, a critical assessment is required and the use of these devices needs to be put in perspective. This article reviews the mechanisms, advantages and limitations of these techniques along with the current evidence available regarding their influence on major clinical outcomes.

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Continuous plasmafiltration in sepsis syndrome

Abstract: PF caused a significant attenuation of the acute-phase response in sepsis. There was no significant difference in mortality, but there was a trend toward fewer organs failing in the PF group that suggests that this procedure might be beneficial.

Cited by 203 publications

References 52 publications

Clinical review: Blood purification for sepsis

Clinical review: Blood purification for sepsis

Coupled Plasma Filtration Adsorption: Rationale, Technical Development and Early Clinical Experience

Emerging Therapies for Extracorporeal Support

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