Coupled Plasma Filtration-adsorption
In the past 25 years, various techniques have been developed to remove endotoxin and/or the sepsis mediators produced and released during the interaction between the host and the infecting agent . The rationale of this approach is based on the hypothesis that a reduction in the blood concentration of these compounds should determine a gradient favoring the elimination of these substances from the target cells . All the techniques used so far are based on the passage of the blood through an extracorporeal circuit containing one or more filters that are supposed to exert their depurative effects either via the elimination of these substances or by sticking them on their surface. The first approach takes advantage of the membranes normally used during continuous renal replacement treatment (CRRT) for the treatment of acute kidney injury (AKI), the cut-off values of which are high enough to allow elimination of medium-high molecular weight (MW) mediators; to this aim, different blood flows (Qb) and ultrafiltrate flows (Qf) have been and are currently used. A second approach consists of use of plasma exchange, aimed at removing of one or more volumes of plasma, which is replaced with colloids, albumin or fresh frozen plasma (FFP) .
KeywordsSeptic Shock Severe Sepsis Acute Kidney Injury Fresh Freeze Plasma Septic Shock Patient
Unable to display preview. Download preview PDF.
- 10.Lentini P, Cruz D, Nalesso F, et al (2009) [A pilot study comparing pulse high volume hemofiltration (pHVHF) and coupled plasma filtration adsorption (CPFA) in septic shock patients]. G Ital Nefr 26: 695–703Google Scholar
- 13.Berlot G, Bianco N, Tomasini A, Vassallo MC, Bianco F (2011) Changes in microvascular blood flow during couple plasma filtration and adsorption. Anesth Intensive Care 39: 687–689Google Scholar
- 14.De Backer D, Verdant C, Chierego M, Gullo A, Vincent JL (2006) Effects of drotrecogin alpha activated on microcirculatory alteration in patients with severe sepsis. Crit Care Med 34: 1919–1924Google Scholar
- 19.Berlot G, Vassallo MC, Busetto N, et al (2012) Relationship between the timing of administration of IgM and IgA-enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: a retrospective analysis. J Crit Care (in press)Google Scholar