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Du Département d’anesthésie-réanimation, pavillon P réanimation, Hôpital Edouard Herriot, Lyon, France.
Adresser la correspondance à : Dr Mathieu Page, Département d’anesthésie réanimation, pavillon P réanimation, hôpital Edouard Herriot, 5 place d’Arsonval, 69437 Lyon Cedex 03 France. Téléphone : +33 4 72 11 02 13 ; Télécopieur : +33 4 72 11 02 75 ; Courriel : page.mat{at}gmail.com
Purpose: Septic shock is the leading cause of multiple organ failure and mortality in intensive care units. This condition seems to be related to an overproduction of both pro- and anti-inflammatory mediators, leading to an immunological dysfunction. Therapeutic strategies aimed at reducing blood and tissue concentrations of these mediators have been developed. One of these techniques, based on extra-renal filtration, is called "coupled plasma filtration and adsorption".
Source: English and French language articles published between 1984 and 2008 were identified through a computerized Medline search. Keywords and MeSH terms used were: «coupled plasmafiltration», «coupled plasma filtration», «adsorption», «blood purification», «cytokines», «hemofiltration», «sepsis». Relevant publications were retrieved and scanned for additional sources. Nine publications were found.
Principal findings: Coupled plasma filtration adsorption is an extra-corporeal treatment, based on non-specific cytokine adsorption on a specially designed resin cartridge, coupled with hemofiltration. Experimental studies and the first clinical trials have shown interesting results regarding hemodynamics and respiratory parameters. However, these trials failed to demonstrate any improvement in outcome.
Conclusion: Additional evidence is needed to clarify the role of this blood purification technique for the treatment of septic shock.
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9 Cruz DN, Perazella MA, Bellomo R, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care 2007; 11: R47.[Medline]
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12 Ronco C, Brendolan A, Lonnemann G, et al. A pilot study of coupled plasma filtration with adsorption in septic shock. Crit Care Med 2002; 30: 1250–5.[Medline]
13 Honore PM, Joannes-Boyau O. High volume hemofiltration (HVHF) in sepsis: a comprehensive review of rationale, clinical applicability, potential indications and recommendations for future research. Int J Artif Organs 2004; 27: 1077–82.[Medline]
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15 Ronco C, Bellomo R, Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 2000; 356: 26–30.[Medline]
16 Saudan P, Niederberger M, De Seigneux S, et al. Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure. Kidney Int 2006; 70: 1312–7.[Medline]
17 VA/NIH Acute Renal Failure Trial Network; Palevsky PM, Zhang JH, O’Connor TZ, et al Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008; 359: 7–20.
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19 Page M, Hayi-Slayman D, Ber CE, et al. Utilisation de la coupled plasma filtration adsorption au cours du traitement d’un choc septique. Ann Fr Anesth Reanim 2007; 26: 990–3.
20 Ronco C, Brendolan A, d’Intini V, Ricci Z, Wratten ML, Bellomo R. Coupled plasma filtration adsorption: rationale, technical development and early clinical experience. Blood Purif 2003; 21: 409–16.[Medline]
21 Schroeder KL, Sallustio JE, Ross EA. Continuous haematocrit monitoring during intradialytic hypotension: precipitous decline in plasma refill rates. Nephrol Dial Transplant 2004; 19: 652–6.
22 Mariano F, Tetta C, Stella M, Biolino P, Miletto A, Triolo G. Regional citrate anticoagulation in critically ill patients treated with plasma filtration and adsorption. Blood Purif 2004; 22: 313–9.[Medline]
23 Formica M, Olivieri C, Livigni S, et al. Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock. Intensive Care Med 2003; 29: 703–8.[Medline]
24 Palevsky PM. Clinical review: timing and dose of continuous renal replacement therapy in acute kidney injury. Crit Care 2007; 11: 232.[Medline]
25 Tetta C, Cavaillon JM, Camussi G, Lonnemann FG, Brendolan A, Ronco C. Continuous plasma filtration coupled with sorbents. Kidney Int Suppl 1998; 66: S186–9.[Medline]
26 Tetta C, Gianotti L, Cavaillon JM, et al. Coupled plasma filtration-adsorption in a rabbit model of endotoxic shock. Crit Care Med 2000; 28: 1526–33.[Medline]
27 Pea F, Viale P, Pavan F, Furlanut M. Pharmacokinetic considerations for antimicrobial therapy in patients receiving renal replacement therapy. Clin Pharmacokinet 2007; 46: 997–1038.[Medline]
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