Coupled Plasma Filtration-adsorption

  • G. Berlot
  • A. Tomasini
  • A. Agbedjro
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)


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 [1]. 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 [2]. 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) [3].


Septic Shock Severe Sepsis Acute Kidney Injury Fresh Freeze Plasma Septic Shock Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rimmelè T, Kellum JA (2011) Clinical review: blood purification for sepsis. Crit Care 15: 205–215PubMedCrossRefGoogle Scholar
  2. 2.
    Honorè PM (2004) Extracorporeal removal for sepsis: acting at the tissue level: the beginning of a new era for this treatment modality in septic shock. Crit Care Med 32: 896–897PubMedCrossRefGoogle Scholar
  3. 3.
    Berlot G, Di Capua G, Nosella P, Rocconi S, Thomann C (2004) Plasmapheresis in sepsis. Contr Nephrol 144: 387–394CrossRefGoogle Scholar
  4. 4.
    Davies B, Davies J (2010) Endotoxin removal devices for the treatment of sepsis and septic shock. Lancet Infect Dis 11: 65–71CrossRefGoogle Scholar
  5. 5.
    Bellomo R, Tetta C, Ronco C (2003) Coupled plasma filtration adsorption. Intensive Care Med 29: 1222–1228PubMedCrossRefGoogle Scholar
  6. 6.
    Tetta C, Cavaillon JM, Schulze M, et al (1998) Removal of cytokines and complement componenst in experimental model of continuous plasma filtration coupled with sorbent adsorption. Nephrol Dial Transplant 13: 1458–1464PubMedCrossRefGoogle Scholar
  7. 7.
    Tetta C, Gianotti L, Cavaillon JM, et al (2000) Coupled plasmafiltration-adsorption in a rabbit model of endotoxic shock. Crit Care Med 28: 1526–1533PubMedCrossRefGoogle Scholar
  8. 8.
    Sykora R, Chvojka J, Krouzecky A, et al (2009) Coupled plasma filtration and adsorption in experimental peritonitis-induced septic shock. Shock 31: 473–480PubMedCrossRefGoogle Scholar
  9. 9.
    Ronco C, Brendolan A, Lonneman NG, et al (2002) A randomized cross-over study of coupled plasmafiltration-with adsorption in septic shock. Crit Care Med 30: 1250–1255PubMedCrossRefGoogle Scholar
  10. 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
  11. 11.
    Turani F, Falco M, Natoli S, Leonardis F, et al (2010) Coupled plasma filtration and adsorption in septic shock: a multicentric experience. Crit Care 14 (Suppl 1): P412 (abst)CrossRefGoogle Scholar
  12. 12.
    Formica M, Olivieri C, Livigni S, et al (2003) Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock. Intensive Care Med 29: 703–708PubMedGoogle Scholar
  13. 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. 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
  15. 15.
    Dellinger RP, Levy MM, Carlet JM, et al (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34: 17–60PubMedCrossRefGoogle Scholar
  16. 16.
    Karvellas CJ, Farhat MR, Sajjad I, Morgensen SS, leuna AA, Wald R, Bagshaw SM (2011) A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 15: R72PubMedCrossRefGoogle Scholar
  17. 17.
    Turgeon AF, Hutton B, Fergusson DA, et al (2007) Meta-analysis: intravenous immunoglobulin in critically ill adult patients with sepsis. Ann Intern Med 146: 193–203PubMedCrossRefGoogle Scholar
  18. 18.
    Neilson AR, Burchardi H, Schneider H (2005) Cost-effectiveness of immunoglobulin Menriched immunoglobulin (Pentaglobin) in the treatment of severe sepsis and septic shock. J Crit Care 20: 239–250PubMedCrossRefGoogle Scholar
  19. 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
  20. 20.
    Dahaba AA, El-Awadi GA, Rehak PH, List WF (2002) Procalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care 30: 269–274PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • G. Berlot
  • A. Tomasini
  • A. Agbedjro

There are no affiliations available

Personalised recommendations