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

Toft, Palle; Schmidt, René; Broechner, A.C.; Nielsen, B.U.; Bollen, Peter; Olsen, Karen Ege

doi:10.1159/000113507

Cited by 14 publications

(8 citation statements)

References 37 publications

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“…After the treatment, symptoms of sepsis (fever, leukocytosis, and unstable hemodynamic status) and liver dysfunction (increase of bilirubin and transaminase levels) were all relieved significantly ( fig. 2 ) just as reported by other authors [14,16] . The patient's vital signs stabilized immediately after 3 times of hemoperfusion and plasmapheresis.…”

Section: Discussionsupporting

confidence: 80%

Successful Treatment of Crush Syndrome Complicated with Multiple Organ Dysfunction Syndrome Using Hybrid Continuous Renal Replacement Therapy

Qin¹,

Baihai²,

Fu³

et al. 2009

Blood Purif

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Background: The M8.1 ‘Wenchuan’ earthquake occurred on May 12th 2008 causing many injuries and casualties. We report a case with crush syndrome and multiple organ dysfunction syndrome (MODS) successfully treated with hybrid continuous renal replacement therapy (CRRT). Method: The patient is a 16-year-old female who was rescued from a collapsed building after 17 h. Emergency amputation was performed. Infections and crush syndrome caused sepsis, acute respiratory distress syndrome, acute renal failure, heart failure, liver dysfunction and disseminated intravascular coagulation in a short time. Hybrid CRRT including high volume hemofiltration, low temperature blood purification, hemoperfusion using endotoxin adsorbent as well as plasmapheresis was performed. Result: After the hybrid CRRT treatment, the patient’s condition improved progressively. Functions of lung, heart, liver and kidney recovered. Sepsis was controlled. CRRT treatment continued for 550 h without stop. She was followed up for 6 months without any sign of residual organ dysfunction. Conclusion: Hybrid CRRT is an effective treatment for patients with severe crush syndrome complicated with MODS.

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Section: Discussionsupporting

confidence: 80%

Successful Treatment of Crush Syndrome Complicated with Multiple Organ Dysfunction Syndrome Using Hybrid Continuous Renal Replacement Therapy

Qin¹,

Baihai²,

Fu³

et al. 2009

Blood Purif

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show abstract

“…Only very limited data are available in the medical literature regarding plasmapheresis, plasma exchanges, and related techniques for this indication [51-55]. 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].…”

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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“…New blood purification techniques, such as high-volume hemofiltration, coupled-apheresis and adsorption, large-pore HF or HD, might modulate immune system to some extent, but a lot of controversies exist on this point. So the clinical value of these techniques remains further research [16,17] . Recent research has pointed to the pivotal role that ECs plays in severe sepsis.…”

Section: Discussionmentioning

confidence: 99%

Endothelial Bioreactor Ameliorates Endotoxemia Sepsis in Swine

Xie

Liu

et al. 2009

Blood Purif

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Introduction: Severe sepsis involves a complex response including the activation of lots of cells, inflammatory mediators, and the hemostatic system. Central to this process is an alteration of endothelial cell function. Therefore, we investigated whether an endothelial bioreactor (EBR) would provide a new therapeutic approach to this clinical disorder. Methods: EBR was constructed using a cartridge which contained with nonwoven polytetrafluoroethylene seeded with porcine iliac artery endothelial cell (PIEC). Pigs were intravenously administered with 0.25 mg/kg lipopolysaccharide and immediately placed in an extracorporeal circuit with EBR or sham controls. Results: Compared with the sham group, EBR therapy resulted in significantly higher mean arterial blood pressure and significantly lower plasma von Willebrand factor, endothelin-1 and scores of lung injury. These alterations were associated with a significant survival advantage in the EBR group. Conclusions: Timely intervention with EC therapy in a tissue-engineered bioreactor may improve cardiovascular performance and alter the natural history of endotoxemia sepsis.

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

Cited by 14 publications

References 37 publications

Successful Treatment of Crush Syndrome Complicated with Multiple Organ Dysfunction Syndrome Using Hybrid Continuous Renal Replacement Therapy

Successful Treatment of Crush Syndrome Complicated with Multiple Organ Dysfunction Syndrome Using Hybrid Continuous Renal Replacement Therapy

Clinical review: Blood purification for sepsis

Endothelial Bioreactor Ameliorates Endotoxemia Sepsis in Swine

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