Adsorption in sepsis.
The pathophysiology of sepsis offers a highly complicated scenario. In sepsis, endotoxin or other gram-positive-derived products induce a complex and dynamic cellular response, giving rise to several mediators known to be relevant in the pathogenesis of septic shock such as specific mediators, substances responsible for up- or down-regulation of cytokine receptors and cytokine antagonists, inactivators of translational or transductional pathways, and precursor molecules. In this review, we delve into some new concepts stemming up from the use of sorbents in continuous plasma filtration. Nonspecific simultaneous removal of several mediators of the inflammatory cascade have led to improved outcomes in animal models of septic shock and to improved hemodynamics in a pilot clinical study. It seems of great importance to explore all possible treatment techniques that may have a direct impact on circulating mediators of sepsis and that also may interfere with the imbalance between proinflammatory and anti-inflammatory substances in the critically ill patient with multiple organ failure. In this view, the application of sorbents appears to open new and interesting therapeutic options. The search for innovative treatments specifically targeted to the special needs of the critically ill patients seems therefore more important than the attempt to adjust concepts and technologies that are normally applied to patients with chronic renal failure.
Renal Research Institute, New York, New York 10128, USA. cronco@rriny.com
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Ronco
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Brendolan
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Dan
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Piccinni
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Bellomo
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De Nitti
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Inguaggiato
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Tetta
D000327:Adsorption; D000818:Animals; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D006435:Renal Dialysis; D018805:Sepsis / Q000150:complications* / Q000276:immunology / Q000503:physiopathology*