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Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock
Marco Formica1, Carlo Olivieri, Sergio Livigni
1Divisione di Nefrologia e Dialisi, Ospedale Torino Nord Emergenza, San Giovanni Bosco, Turin, Italy. formica.m@scroce.sanitacn.it
Intensive Care Medicine
|April 1, 2003
Summary
Coupled plasmafiltration-adsorption significantly improved hemodynamic function and pulmonary function in septic shock patients. This extracorporeal treatment demonstrated feasibility, safety, and improved patient outcomes, including reduced vasopressor needs and enhanced survival rates.
Area of Science:
- Critical Care Medicine
- Nephrology
- Cardiovascular Medicine
Background:
- Septic shock is a life-threatening condition characterized by circulatory dysfunction.
- Existing treatments for septic shock have limitations in improving hemodynamic stability and organ function.
- Extracorporeal therapies are being explored to augment conventional management of septic shock.
Purpose of the Study:
- To evaluate the impact of repeated coupled plasmafiltration-adsorption (CPA) sessions on hemodynamic parameters in intensive care unit (ICU) patients with septic shock.
- To assess the safety and feasibility of CPA in this patient population.
- To determine the effect of CPA on pulmonary function, vasopressor requirements, and patient outcomes.
Main Methods:
- A prospective, intention-to-treat study was conducted in a general ICU.
- Twelve mechanically ventilated septic shock patients, with or without acute renal failure (ARF), received a median of 10 CPA sessions.
- Hemodynamic parameters, pulmonary function (PO2/FIO2 ratio), vasopressor use, C-reactive protein (CRP) levels, and survival rates were monitored.
Main Results:
- Significant improvements were observed in mean arterial pressure, cardiac index, and systemic vascular resistance index post-treatment.
- The PO2/FIO2 ratio improved significantly, indicating enhanced pulmonary function.
- Vasopressor requirements (norepinephrine) were substantially reduced, and C-reactive protein levels decreased significantly.
- Survival rates were 90% at day 28 and 70% at day 90.
Conclusions:
- Coupled plasmafiltration-adsorption is a feasible and safe extracorporeal treatment for septic shock patients.
- CPA leads to remarkable improvements in hemodynamics, pulmonary function, and overall patient outcomes.
- The therapy is effective in patients with or without acute renal failure, offering a promising adjunctive treatment option.