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

Ataman, Karin; Jehmlich, M.; Kock, Sabine; Neumann, Sabine; Leischik, M.; Filipovic, Zoran; Hopf, Hans‐Bernd

doi:10.1007/s00134-002-1375-6

Cited by 15 publications

(13 citation statements)

References 7 publications

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“…In the present study, plasmapheresis did not improve the hemodynamics. This is in accordance with a recent retrospective study by Ataman et al [18] who failed to demonstrate any significant improvement in cardiovascular parameters during the first 24 h after plasmapheresis.…”

Section: Discussionsupporting

confidence: 81%

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

Toft

Schmidt²,

Broechner³

et al. 2008

Blood Purif

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Background: It has been proposed that plasmapheresis is most effective when applied early in Gram-negative sepsis. We therefore studied the effect of early plasmapheresis on immunity in experimental Escherichia coli endotoxin-induced sepsis. Methods: 20 pigs received 30 µg/kg of E. coli endotoxin. 40 min later, half of the pigs were treated with plasmapheresis which lasted 4 h. The adhesion molecules, the oxidative burst, the number of neutrophils in blood and lungs, and cytokines were measured. Results: Infusion of endotoxin was associated with activation of adhesion molecules increased oxidative burst, increased concentration of cytokine, and accumulation of granulocytes in lung tissue. Plasmapheresis reduced the oxidative burst, and there was a tendency towards a reduced accumulation of granulocytes in the lung. Conclusion: Though plasmapheresis was initiated early after the endotoxin infusion, it only temporarily attenuated a part of the activated cell-mediated immunity.

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Section: Discussionsupporting

confidence: 81%

“…In the study by Ataman et al [18] the mean duration of sepsis was 5 days and that of septic shock 2 days before plasmapheresis was performed. In the present study we initiated treatment with plasmapheresis within 40 min after the infusion of endotoxin to evaluate if this early intervention could diminish the inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

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

Toft

Schmidt²,

Broechner³

et al. 2008

Blood Purif

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“…The obvious conclusion is therefore not to hesitate in transiently increasing the dosage of catecholamines if the patient is vasoplegic and hyperkinetic (although this remains experimental) or to use alternative therapies [57]. In this particular case, which is associated with a dramatic prognosis, other agents such as vasopressin or terlipressin [58], methylene blue [59], high volume hemofiltration [60], or plasmapheresis [61] have demonstrated their efficiency in case report studies or small series.…”

Section: Catecholaminesmentioning

confidence: 97%

Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside

Lévy

Collin

Sennoun

et al. 2012

Applied Physiology in Intensive Care Medicine 2

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Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside Abstract Purpose: To delineate some of the characteristics of septic vascular hypotension, to assess the most commonly cited and reported underlying mechanisms of vascular hyporesponsiveness to vasoconstrictors in sepsis, and to briefly outline current therapeutic strategies and possible future approaches. Methods: Source data were obtained from a PubMed search of the medical literature with the following MeSH terms: Muscle, smooth, vascular/ physiopathology; hypotension/etiology; shock/physiopathology; vasodilation/physiology; shock/therapy; vasoconstrictor agents. Results: Nitric oxide (NO) and peroxynitrite are crucial components implicated in vasoplegia and vascular hyporeactivity. Vascular ATP-sensitive and calcium-activated potassium channels are activated during shock and participate in hypotension. In addition, shock state is characterized by inappropriately low plasma glucocorticoid and vasopressin concentrations, a dysfunction and desensitization of alpha-receptors, and an inactivation of catecholamines by oxidation. Numerous other mechanisms have been individualized in animal models, the great majority of which involve NO: MEK1/2-ERK1/2 pathway, H 2 S, hyperglycemia, and cytoskeleton dysregulation associated with decreased actin expression. Conclusions: Many therapeutic approaches have proven their efficiency in animal models, especially therapies directed against one particular compound, but have otherwise failed when used in human shock. Nevertheless, high doses of catecholamines, vasopressin and terlipressin, hydrocortisone, activated protein C, and non-specific shock treatment have demonstrated a partial efficiency in reversing sepsis-induced hypotension.

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“…The ability of plasma manipulation to change the levels of circulating mediators appears to depend on the method that is used. Conventional plasma exchange does not consistently affect plasma or serum levels of interleukin-6, interleukin-6 receptor, tumor necrosis factor-α, tumor necrosis factor-α receptor, or C-reactive protein [180][181][182]. By comparison, continuous plasmafiltration or selective adsorption techniques can reduce various inflammatory cytokine levels and may improve hemodynamic parameters in some patients [183][184][185][186][187].…”

Section: Miscellaneous Conditions In Severely Ill Patientsmentioning

confidence: 99%

“…Plasma exchange, either alone or combined with hemofiltration, has been more widely used and evaluated in the critical care setting [reviewed in 117,185,189]. Recent observational studies in patients with sepsis and/or MODS (including many with renal failure requiring peritoneal dialysis, hemodialysis, or hemofiltration) have shown either no effect of exchange or plasmafiltration on cardiovascular parameters [182] and/or mortality [183] or a decrease in early death ranging from 28% (when combined with hemofiltration) [190] to more than 75% [191]. The only published randomized controlled trial demonstrated a 20.5% reduction in the 28-day all-cause mortality (from 53.8% to 33.3%) among patients with severe sepsis or septic shock treated with 1 or 2 daily plasma exchanges (n = 54) compared with untreated control patients (n = 52) [192].…”

Section: Miscellaneous Conditions In Severely Ill Patientsmentioning

confidence: 99%

Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications

Linenberger

Price

2005

J Intensive Care Med

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Apheresis is the process of separating the blood and removing or manipulating a cellular or plasma component for therapeutic benefit. Such procedures may be indicated in the critical care setting as primary or adjunctive therapy for certain hematologic, neurologic, renal, and autoimmune/rheumatologic disorders. In part I of this series, the technical aspects of apheresis were described and the physiologic rationale and clinical considerations were discussed. This review highlights the pathophysiologic basis, specific clinical indications, and treatment parameters for disorders that more commonly require management in the intensive care unit. The choice of plasma or cellular apheresis in these cases is guided by well-accepted, evidence-based clinical treatment guidelines. For some disorders, such as liver failure, severe sepsis, and multiple-organ dysfunction syndrome, apheresis treatment approaches remain experimental. Ongoing studies are investigating the potential utility of conventional plasma exchange, ex vivo plasma manipulation, and newer technologies for these and other disorders in severely ill patients.

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

Cited by 15 publications

References 7 publications

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

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

Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside

Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications

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