Intensive Care Medicine

, Volume 29, Issue 5, pp 703–708 | Cite as

Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock

  • Marco Formica
  • Carlo Olivieri
  • Sergio Livigni
  • Giulio Cesano
  • Antonella Vallero
  • Mariella Maio
  • Ciro Tetta



The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs).


Prospective, intention-to-treat.


General ICU of a tertiary care, non-teaching, 400-bed, city hospital.

Patients and participants

Twelve consecutive mechanically ventilated septic shock patients, with or without concomitant acute renal failure (ARF).


A median of 10 consecutive sessions (prescribed treatment time: 10 h/session; delivered duration: 8.43±1.37 h/min) of coupled plasmafiltration-adsorption for each patient.

Measurements and results

Mean arterial pressure (77.2±12.5 [CI 95%; 74.5–79.8] vs. 83.3±14.1 [CI 95%; 80.3–86.3] mm Hg; [p<0.001]), cardiac index (4.03±0.89 [CI 95%; 3.83–4.22] vs. 3.46±0.82 [CI 95%; 3.28–3.64] L/m2/min; [p<0.001]), systemic vascular resistance index (1,388±496 [CI 95%; 1,278–1,497] vs. 1,753±516 [CI 95%; 1,639–1,867] dynes × s/cm5; [p<0.001]), PO2/FIO2 ratio (204±87 [CI 95%; 185–223] vs. 238±82 [CI 95%; 220–256]; [p<0.001]), significantly improved during 100 global treatments (pre- vs. post-treatment values). Intra-thoracic blood volume and extra-vascular lung water did not change across treatments. Vasopressor requirement was reduced: norepinephrine decrease from an infusion rate of 0.13±0.07 (CI 95%; 0.06–0.16) to 0 γ/kg/min after a mean of 5.3±2.7 sessions. C reactive protein (CRP) significantly decreased (from 29.3±7.3 vs. 7.9±4.8; p<0.0001) during treatment. Survival was 90% at day 28 and 70% at day 90.


Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.


Septic shock Multi organ dysfunction syndrome Plasmafiltration Adsorption Hemodynamics Acute renal failure 


  1. 1.
    Friedman G, Silva E, Vincent JL (1998) Has mortality of septic shock changed with time? Crit Care Med 26:2078–2086Google Scholar
  2. 2.
    Wheeler AP, Bernard GR (1999) Treating patients with sepsis. N Engl J Med 340:207–214PubMedGoogle Scholar
  3. 3.
    USA National Vital Statistics Report (2001) 49:6Google Scholar
  4. 4.
    Liano G, Pascual J (1996) Acute renal failure. Madrid Acute Renal Failure Study Group. Lancet 17:347–349Google Scholar
  5. 5.
    Thijs A, Thijs LG (1998) Pathogenesis of renal failure in sepsis. Kidney Int 53 [Suppl 66]:S34–S37Google Scholar
  6. 6.
    Rangel-Frausto MS, Pittet D, Costigan M (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123PubMedGoogle Scholar
  7. 7.
    Bellomo R, Ronco C (1998) Indications and criteria for initiating renal replacement therapy in the intensive care unit. Kidney Int 53 [Suppl 66]:S106–S109Google Scholar
  8. 8.
    Kellum JA, Johnson JP, Kramer D, Pavelsky P, Brady JJ, Pinsky MR (1998) Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome. Crit Care Med 26:1995–2000PubMedGoogle Scholar
  9. 9.
    Bellomo R, Baldwin I, Cole L, Ronco C (1988) Preliminary experience with high volume hemofiltration in human septic shock. Kidney Int 53:182–185Google Scholar
  10. 10.
    Reeves JH, Butt WW, Shann F, Layton JE, Stewart A, Waring PM, Presneill JJ (1999) Continuous plasmafiltration in sepsis syndrome. Crit Care Med 27:2096–2104Google Scholar
  11. 11.
    Tetta C, Gianotti L, Cavaillon JM, Wratten ML, Fini M, Braga M, Bisagni P, Giavaresi GL, Bolzani R, Giardino R (2000) Continuous plasmafiltration coupled with sorbent adsorption in a rabbit model of endotoxic shock. Crit Care Med 28:1526–1533PubMedGoogle Scholar
  12. 12.
    Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A, Dan M, Irone M, La Greca G, Inguaggiato P, Maggiore U, De Nitti C, Wratten ML, Ricci Z, Tetta C (2002) A pilot study on coupled plasma filtration with adsorption in septic shock. Crit Care Med 30:1250–1255PubMedGoogle Scholar
  13. 13.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ (ACCP/SCCM Consensus conference committee (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655PubMedGoogle Scholar
  14. 14.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedGoogle Scholar
  15. 15.
    Tetta C, Cavaillon JM, Schulze M, Ronco C, Ghezzi PM, Camussi G, Serra AM, Curti F, Lonnemann G (1998) Removal of cytokines and activated complement components in an experimental model of continuous plasma filtration coupled with sorbent adsorption. Nephrol Dial Transplant 13:1458–1464CrossRefPubMedGoogle Scholar
  16. 16.
    Godje O, Hoke K, Fischlein T, Vetter H, Reichart B (1996) Less invasive, continuous cardiac output measurement through pulse contour analysis versus conventional thermal dilution. Intensive Care Med 22:S58Google Scholar
  17. 17.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome and associated costs of care. Crit Care Med 29:1303–1310PubMedGoogle Scholar
  18. 18.
    De Vriese AS, Vanholder RC, De Sutter JH, Colardyn FA, Lameire NH (1998) Continuous renal replacement therapies in sepsis: where are the data? Nephrol Dial Transplant 13:1362–1364PubMedGoogle Scholar
  19. 19.
    Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G (2000) Effect of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomized trial. Lancet 356:26–30PubMedGoogle Scholar
  20. 20.
    Cole L, Bellomo R, Journois D, Davenport P, Baldwin I, Tipping P (2001) High-volume hemofiltration in human septic shock. Intensive Care Med 27:978–986PubMedGoogle Scholar
  21. 21.
    Cole L, Bellomo R, Hart G, Journois D, Davenport P, Tipping P, Ronco C (2002) Crit Care Med 30:100–106Google Scholar
  22. 22.
    Carlet J (2001) Immunological therapy in sepsis: currently available. Guidelines for the management of severe sepsis and septic shock. Intensive Care Med 27:S93–S103PubMedGoogle Scholar
  23. 23.
    De Vriese AS, Colardyn FA, Philippe JJ, Vanholder RC, De Sutter JH, Lameire NH (1999) Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol 10:846–853PubMedGoogle Scholar
  24. 24.
    Opal SM (2000) Hemofiltration-absorption systems for the treatment of experimental sepsis: is it possible to remove the "evil humors" responsible for septic shock? Crit Care Med 28:1681–1682PubMedGoogle Scholar
  25. 25.
    Yekebas EF, Eisenberger CF, Ohnesorge H, Saalmuller A, Elsner HA, Engelhardt M, Gillesen A, Meins J, The M, Strate T, Busch C, Knoefel WT, Bloechle C, Izbicki JR (2001) Attenuation of sepsis-related immunoparalysis by continuous veno-venous hemofiltration in experimental porcine pancreatitis. Crit Care Med 29:1423–1430PubMedGoogle Scholar
  26. 26.
    Schor N (2002) Acute renal failure and the sepsis syndrome. Kidney Int 61:764–776CrossRefPubMedGoogle Scholar
  27. 27.
    Langer M, Riccardi F, Piovella F, Klersy C (2002) Use of anticoagulants in patients with sepsis. JAMA 287:448–489CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Marco Formica
    • 1
    • 4
  • Carlo Olivieri
    • 2
  • Sergio Livigni
    • 2
  • Giulio Cesano
    • 1
    • 5
  • Antonella Vallero
    • 1
  • Mariella Maio
    • 2
  • Ciro Tetta
    • 3
    • 6
  1. 1.Divisione di Nefrologia e DialisiOspedale Torino Nord Emergenza San Giovanni BoscoTorinoItaly
  2. 2.Terapia Intensiva e RianimazioneOspedale Torino Nord Emergenza San Giovanni BoscoTorinoItaly
  3. 3.Clinical and Laboratory Research DepartmentBellcoMirandolaItaly
  4. 4.Divisione di Nefrologia e DialisiAzienda Ospedaliera S.Croce e CarleCuneoItaly
  5. 5.Divisione di Nefrologia e DialisiOspedale CivileAstiItaly
  6. 6.Renal Research, Division of MedicineFresenius Medical CareBad HomburgGermany

Personalised recommendations