A pilot study of coupled plasma filtration with adsorption in septic shock.

摘要: Objective: To test the hypothesis that nonselective plasma adsorption by a hydrophobic resin (coupled plasmafiltration and adsorption) could improve hemodynamics restore leukocyte responsiveness in patients with septic shock. Design: Prospective, pilot, crossover clinical trial. Setting: General intensive care unit teaching hospital. Subjects: Ten hyperdynamic Interventions: Patients were randomly allocated to 10 hrs of either coupled filtration plus hemodialysis (treatment A) or continuous venovenous hemodiafiltration B) random order. We measured change mean arterial pressure, norepinephrine requirements, tumor necrosis factor- (TNF-) production (both spontaneous lipopolysaccharide-stimulated) after each treatment. also tested TNF- from normal human adherent monocytes incubated patients’ obtained before resin, both without incubation an anti-interleukin-10 monoclonal antibody. Results: Mean pressure increased hr 11.8 mm Hg treatment A 5.5 B (p .001). There was average decrease requirement 0.08 g/kg/min 0.0049 g/ kg/min .003). All but one survived. Spontaneous lipopolysaccharide-induced whole blood over time A. This increase more marked drawn device (plasmafiltrate-sorbent hemodialyzer) .009). Preresin suppressed lipopolysaccharide-stimulated 1 6 cultured healthy donors. suppressive effect significantly reduced passage through .019) antibodies .028). Conclusions: In shock, plasmafiltration-adsorption combined associated improved compared hemodiafiltration. result might be related its ability lipopolysaccharide. These findings suggest potential role for purification (Crit Care Med 2002; 30:1250 ‐1255)