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Therapeutic plasma exchange in severe sepsis or septic shock
1Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
Abstract:
Endotoxic shock with multiorgan dysfunction syndrome (MODS) is fatal in more than 80% of cases and is the leading cause of death in patients admitted to intensive care units. The incidence has increased to more then 100% in the last 10 years and there has been no significant decreases in its morbidity and mortality. The systemic inflammatory response to infection, e.g. sepsis, develops when the endotoxins activate various cascade systems. The activation of the cascade systems triggers further release of various active substances and cytokines. The progress may result in consumption coagulopathy, which may further generate an acute septic shock, disseminated intravascular coagulation, and MODS. When more than 3 organs are involved, the risk of fatal outcome exceeds 80%. The use of plasma exchange may be a beneficial adjunct to therapy during a progressive septic shock with MODS, when the patient does not respond to classical intensive care unit therapy. The beneficial effect, recently reported for plasma exchange procedures in patients with sepsis, may be due to the removal of various toxins and waste products from the blood, and administration of plasma from healthy subjects.
Insights
Endotoxic shock and multiorgan dysfunction syndrome (MODS) are highly fatal. Plasma exchange may offer a beneficial adjunctive therapy for progressive septic shock with MODS unresponsive to standard intensive care unit treatments.
Area of Science:
- Critical Care Medicine
- Immunology
- Pathophysiology
Background:
- Endotoxic shock with multiorgan dysfunction syndrome (MODS) is a leading cause of death in intensive care units, with over 80% fatality.
- The incidence of MODS has increased significantly, with no substantial improvements in morbidity or mortality.
- Sepsis-induced systemic inflammatory response involves endotoxin activation of cascade systems, leading to cytokine release and potential organ failure.
Purpose of the Study:
- To evaluate the potential benefit of plasma exchange as an adjunctive therapy for patients with progressive septic shock and MODS.
- To explore the mechanisms by which plasma exchange might improve outcomes in severe sepsis.
Main Methods:
- Review of recent reports on plasma exchange procedures in sepsis patients.
- Analysis of the potential effects of plasma exchange in removing toxins and administering supportive plasma components.
Main Results:
- Plasma exchange may be a beneficial adjunct for severe septic shock with MODS unresponsive to conventional intensive care.
- The efficacy of plasma exchange may stem from the clearance of blood toxins and waste products.
- Administration of plasma from healthy donors could contribute to therapeutic benefits.
Conclusions:
- Plasma exchange shows promise as a supportive therapy in critical cases of septic shock with MODS.
- Further investigation into plasma exchange for sepsis management is warranted.
- Targeted removal of endotoxins and inflammatory mediators via plasma exchange could mitigate organ dysfunction.