Coupled plasma filtration adsorption for the treatment of a patient with acute respiratory distress syndrome and acute kidney injury: a case report

Abstract

Coupled plasma filtration adsorption (CPFA) is an extracorporeal blood purification therapy based on non-specific pro- and anti-inflammatory mediator adsorption on a special resin cartridge coupled with continuous veno-venous haemofiltration or continuous veno-venous haemodiafiltration and is one of the emerging treatments for septic patients. However, in the literature, there are limited data about its efficacy in treating patients with acute diseases but without the traditional criteria for sepsis. We describe the case of a 43-year-old male who developed acute respiratory distress syndrome secondary to pneumonia and acute kidney injury, whose clinical conditions rapidly improved after early CPFA therapy.

A Pilot Study of Selective Lipopolysaccharide Adsorption and Coupled Plasma Filtration and Adsorption in Adult Patients with Severe Sepsis

“…These effects can be caused by the reduction of endotoxin concentration during haemoperfusion with the Toraymyxin™-PMX-F column and by the decrease in the large spectrum of inflammation mediators and enzyme levels that initiate lung injury [18,19,20,21,22]. …”

Clinical use of plasmafiltration coupled with adsorption

“…[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.…”

Advances in Hemodialysis Techniques

“…Finally, adsorption techniques have been used successfully, in conjunction with plasma filtration and hemofiltration, in clearing efficiently pro-inflammatory mediators in experimental animals [108] and in humans with acute kidney injury and sepsis [109]. This is known as "coupled plasma filtration adsorption" (CPFA) technique, where the treatment consists of the separation of plasma from the whole blood, using a plasma filter with high cutoff membrane of 800,000 Dalton, coupled with adsorption of the inflammatory mediators and cytokines from plasma, using a cartridge contains hydrophobic resins, followed by hemofiltration using a hemofilter.…”