A pilot study of coupled plasma filtration with adsorption in septic shock.
OBJECTIVE
To test the hypothesis that nonselective plasma adsorption by a hydrophobic resin (coupled plasmafiltration and adsorption) could improve hemodynamics and restore leukocyte responsiveness in patients with septic shock.


METHODS
Prospective, pilot, crossover clinical trial.


METHODS
General intensive care unit in a teaching hospital.


METHODS
Ten patients with hyperdynamic septic shock.


METHODS
Patients were randomly allocated to 10 hrs of either coupled plasma filtration adsorption plus hemodialysis (treatment A) or continuous venovenous hemodiafiltration (treatment B) in random order. We measured the change in mean arterial pressure, norepinephrine requirements, and leukocyte tumor necrosis factor-alpha (TNF-alpha) production (both spontaneous and lipopolysaccharide-stimulated) after 10 hrs of each treatment. We also tested TNF-alpha production from normal human adherent monocytes incubated with patients' plasma obtained before and after the resin, both with or without incubation with an anti-interleukin-10 monoclonal antibody.


RESULTS
Mean arterial pressure increased after 10 hr by 11.8 mm Hg with treatment A and by 5.5 mm Hg with treatment B (p =.001). There was an average decrease of norepinephrine requirement of 0.08 microg/kg/min with treatment A and 0.0049 microg/kg/min with treatment B (p =.003). All patients but one survived. Spontaneous and lipopolysaccharide-induced TNF-alpha production from patients' whole blood increased over time with treatment A. This increase was more marked in blood drawn after the device (plasmafiltrate-sorbent plus hemodialyzer) (p =.009). Preresin plasma suppressed lipopolysaccharide-stimulated production of TNF-alpha by 1 x 10(6)cultured adherent monocytes from healthy donors. This suppressive effect was significantly reduced after passage of plasma through the resin (p =.019) and after incubation with anti-interleukin-10 monoclonal antibodies (p =.028).


CONCLUSIONS
In patients with septic shock, coupled plasmafiltration-adsorption combined with hemodialysis was associated with improved hemodynamics compared with continuous venovenous hemodiafiltration. This result might be related to its ability to restore leukocyte responsiveness to lipopolysaccharide. These findings suggest a potential role for blood purification in the treatment of septic shock.
Ronco
Claudio
C
Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
Brendolan
Alessandra
A
Lonnemann
Gerhard
G
Bellomo
Rinaldo
R
Piccinni
Pasquale
P
Digito
Antonio
A
Dan
Maurizio
M
Irone
Marco
M
La Greca
Giuseppe
G
Inguaggiato
Paola
P
Maggiore
Umberto
U
De Nitti
Concetta
C
Wratten
Mary Lou
ML
Ricci
Zaccaria
Z
Tetta
Ciro
C
D018806:APACHE; D000327:Adsorption; D000328:Adult; D018592:Cross-Over Studies; D006439:Hemodynamics; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D012772:Shock, Septic / Q000145:classification / Q000378:metabolism / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10