Plasmapheresis combined with continuous venovenous hemofiltration in surgical patients with sepsis.
OBJECTIVE
To examine the effect of continuous venovenous hemofiltration (CVVHF) combined with plasmapheresis (TPE) in critically ill surgical patients after treatment of the septic focus.


METHODS
Observational pilot study.


METHODS
University teaching hospital intensive care unit.


METHODS
TPE and CVVHF were administered 24 h after surgical and/or interventional treatment of septic focus. Arterial blood pressure, cardiac output, and systemic vascular resistance values were monitored. We examined the effect of the combined extracorporeal detoxification on outcome related to age, morbidity, organic failure rate, and initial APACHE II score.


RESULTS
Forty-three patients with sepsis were treated; 19 received TPE in combination with CVVHF, and 24 did not receive extracorporeal therapy. Overall mortality was 44.2%. In the therapy group mortality was lower (42.1 vs. 45.8%), but the primary organic failure rate was higher. The relationship between mortality and age was similar in the two groups. There was also no difference between the groups in the course of scores on APACHE II, multiple-organ failure, and sepsis severity. Only patients with an initial APACHE II score of 21-25 had a significant reduction in mortality after combined extracorporeal detoxification. Mortality of 17% in TPE/CVVHF patients with single- (pulmonary) and double-organ failure (renal/pulmonary) was significantly lower (P < 0.0001) than in untreated patients.


CONCLUSIONS
Reduction in mortality in single- and double-organ failure was as high as 28% in septic patients with combined extracorporeal detoxification. A prospective randomized trial in sepsis and double-organ failure should be projected.
Department of Surgery, University Witten-Herdecke, Klinikum Wuppertal, Germany. Johannes.Schmidt@klinikum-wuppertal.de
J
J
Schmidt
S
S
Mann
V D
VD
Mohr
R
R
Lampert
U
U
Firla
H
H
Zirngibl
D018806:APACHE; D016022:Case-Control Studies; D003422:Critical Care; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality*; D010865:Pilot Projects; D010956:Plasmapheresis; D011184:Postoperative Period; D018805:Sepsis / Q000145:classification / Q000401:mortality / Q000601:surgery / Q000628:therapy*