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Rationale for sequential extracorporeal therapy (SET) in sepsis.
Ronco, Claudio; Chawla, Lakhmir; Husain-Syed, Faeq; Kellum, John A.
  • Ronco C; International Renal Research Institute of Vicenza, IRRIV Foundation, Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, aULSS8 Berica, Via Rodolfi, 37, 36100, Vicenza, Italy. cronco@goldnet.it.
  • Chawla L; Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128, Padua, Italy. cronco@goldnet.it.
  • Husain-Syed F; Department of Medicine, Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
  • Kellum JA; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
Crit Care ; 27(1): 50, 2023 02 07.
Article in English | MEDLINE | ID: covidwho-2278711
ABSTRACT
Sepsis and septic shock remain drivers for morbidity and mortality in critical illness. The clinical picture of patients presenting with these syndromes evolves rapidly and may be characterised by (a) microbial host invasion, (b) establishment of an infection focus, (c) opsonisation of bacterial products (e.g. lipopolysaccharide), (d) recognition of pathogens resulting in an immune response, (e) cellular and humoral effects of circulating pathogen and pathogen products, (f) immunodysregulation and endocrine effects of cytokines, (g) endothelial and organ damage, and (h) organ crosstalk and multiple organ dysfunction. Each step may be a potential target for a specific therapeutic approach. At various stages, extracorporeal therapies may target circulating molecules for removal. In sequence, we could consider (a) pathogen removal from the circulation with affinity binders and cartridges (specific), (b) circulating endotoxin removal by haemoperfusion with polymyxin B adsorbers (specific), (c) cytokine removal by haemoperfusion with sorbent cartridges or adsorbing membranes (non-specific), (d) extracorporeal organ support with different techniques for respiratory and cardiac support (CO2 removal or extracorporeal membrane oxygenation), and renal support (haemofiltration, haemodialysis, or ultrafiltration). The sequence of events and the use of different techniques at different points for specific targets will likely require trials with endpoints other than mortality. Instead, the primary objectives should be to achieve the desired action by using extracorporeal therapy at a specific point.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Shock, Septic / Extracorporeal Membrane Oxygenation / Hemoperfusion / Sepsis Type of study: Prognostic study Limits: Humans Language: English Journal: Crit Care Year: 2023 Document Type: Article Affiliation country: S13054-023-04310-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Shock, Septic / Extracorporeal Membrane Oxygenation / Hemoperfusion / Sepsis Type of study: Prognostic study Limits: Humans Language: English Journal: Crit Care Year: 2023 Document Type: Article Affiliation country: S13054-023-04310-2