Coupled plasma filtration and adsorption in septic shock: a multicentric experience

Introduction

Recently extracorporeal removal of mediators and endotoxins improved haemodynamics, organ dysfunction and mortality in patients with abdominal sepsis [1]. Coupled plasma filtration and adsorption (CPFA), too, may improve haemodynamics, respiratory function and mortality through removal of proinflammatory mediator. The aim of this multicentric study is to evaluate the haemodynamic response and the respiratory function, and to evaluate the reduction of inflammatory markers during CPFA.

Methods

Fifty-five septic patients were enrolled in this study. Every patient had four CPFA treatments (LINDA; Bellco-Mirandola, Italy) for 8 hours with Q_b = 200 ml/minute, Q_{ultrafiltration} = 30 ml/kg/hour and Q_plasma = 20% of Q_b. At T0 (basal), T1 (after first cycle), T2 (after second cycle), T3 (after third cycle) and T4 (after fourth cycle) we evaluated haemodynamic parameters, norepinephrine dosage, PaO₂/FiO₂ ratio, plasma IL-6, and procalcitonin (PCT). The ANOVA test was used to compare changes during times study. P < 0.05 was considered statistically significant.

Results

Patients enrolled in the study have been submitted to 256 CPFA treatments for 2,650 hours. Table 1 presents the main results of the study. IV quartile of IL-6 is shown in Table 1.

Table 1

Conclusions

In this large multicentric study, CPFA may improve haemodynamic status and respiratory function. Plasma filtration and adsorption of proinflammatory mediators may explain this improvement. Larger randomized controlled trials are indicated to confirm these data.