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Fig. 4 | Critical Care

Fig. 4

From: Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers

Fig. 4

Ex-vivo effect of plasma obtained from patients with septic shock on endothelial morphology and function. a HUVECs were incubated for 30 min with patients plasma obtained immediately before (left panel) and after (right panel) therapeutic plasma exchange (TPE) ex vivo. Immunofluorescent cytochemistry for the cell-cell contact protein VE-cadherin (green) and the cytoskeletal component f-actin (red) show severe alterations of the endothelial architecture and the formation of paracellular gaps (i.e., the cellular correlate of the clinical capillary leakage syndrome). Incubation of HUVECs with the same patients plasma obtained after TPE did not induce these changes any more. This assay was performed with plasma from all patients. Shown are images from a representative patient. b Transendothelial electrical resistance (TER), a highly quantitative method to assess permeability in real time in vitro, revealed that 60% (12/20) of patients plasma did induce a severe drop in resistance (grey dots). The same patients plasma after TPE did not induce permeability any more (white bars). c 40% (8/20) of patients did not show any response to therapeutic TPE with regard to TER before and after the procedure

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Critical Care

ISSN: 1364-8535