[Plasmapheresis in the treatment of septic shock]

Sepsis is an increasingly common cause of morbidity and mortality and the leading cause of death in intensive care units. In recent years many new therapies for sepsis have been tested in randomised clinical trials, but most of them have failed to reduce mortality. Plasmapheresis is a nonselective method by which plasma is separated from the blood and replaced with donor plasma and/or albumin. The theoretical rationale is that plasmapheresis removes the harmful mediators and replenishes the consumed plasma factors, thus restoring the homeostatic milieu.

This article is based upon own research and a review of the current literature found in PubMed.

Over the last 30 years, several experimental and clinical studies have reported a beneficial effect of plasmapheresis in the treatment of patients with severe sepsis and septic shock. Most of the studies have focused on Gram-negative sepsis. Only a few of the clinical studies are prospective, randomised trials with appropriate control groups.

There is not sufficient evidence to justify the use of plasmapheresis as standard treatment of patients with severe sepsis and septic shock. However, plasmapheresis should be considered for fulminant Gram-negative septic shock. If applied, it should be started urgently and repeated in unresponsive patients and when a patient's clinical condition is deteriorating.