Zusammenfassung
Hintergrund
Diverse pro- und antiinflammatorische Mediatorkaskaden spielen in der Pathophysiologie der Sepsis eine Schlüsselrolle und führen zur Schädigung multipler Organsysteme. Bislang stehen aber nur sehr begrenzt Therapien zur Verfügung, die diese überschießenden Reaktionen des Immunsystems sinnvoll modulieren können.
Lösungsansatz
Eine Adsorption solcher Mediatoren mithilfe einer extrakorporalen Therapie könnte daher eine Bereicherung des therapeutischen Rüstzeugs bei schwerer Sepsis bedeuten. Technische Innovationen der letzten Jahre machen eine solche Therapie auch in der klinischen Praxis durchführbar. Dies kann als Nebeneffekt einer konventionellen Nierenersatztherapie oder als eigenständige extrakorporale Therapie erfolgen. Neben der relativ unspezifischen Adsorption eines breiten Spektrums an Mediatoren stehen sowohl Verfahren zur relativ selektiven Endotoxinadsorption als auch zur spezifischen Immunadsorption zur Verfügung.
Diskussion
Zwar konnten verschiedene Systeme ihre biochemische Wirksamkeit zeigen, jedoch ist für den breiten Einsatz adsorptiver Therapiestrategien derzeit sicherlich die ungenügende Studienlage bezüglich harter klinischer Endpunkte, wie z. B. einer Senkung der hohen Mortalitätsrate bei Sepsis, limitierend. Damit kann ein Einsatz solcher Therapien derzeit außerhalb klinischer Studien (noch) nicht empfohlen werden.
Abstract
Background
The activation of multiple pro- and anti-inflammatory mediators is a key feature in the pathophysiology of sepsis. Many of these mediators may directly contribute to organ dysfunction and determine disease severity. So far our ability to modulate these upregulated mediator pathways is very limited. Therefore the adsorption of such mediators via an extracorporeal circuit may be a beneficial intervention during sepsis.
Objectives
Recent technical innovations have made this intervention feasible. Both systems for exclusive mediator adsorption and for adsorption beside a conventional renal replacement therapy are now available. Some of the membranes can adsorb a broad range of mediators by rather unspecific binding, whereas others specifically adsorb endotoxin or mediators.
Discussion
Whilst biochemical efficacy could be demonstrated by some of the systems, controlled and randomized studies demonstrating improved clinical endpoints are still lacking. Therefore the use of such therapies outside clinical studies cannot yet be recommended.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. D. Hasper, J.C. Schefold und A. Jörres geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Hasper, D., Schefold, J. & Jörres, A. Adsorbertherapie bei Sepsis. Med Klin Intensivmed Notfmed 110, 272–277 (2015). https://doi.org/10.1007/s00063-014-0415-7
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DOI: https://doi.org/10.1007/s00063-014-0415-7