Roles of extracorporeal blood purification in sepsis.
Severe sepsis represents the leading cause of mortality and morbidity in critically ill patients. Although the authors' understanding of the complex pathophysiological alterations that occur in severe sepsis and septic shock has increased greatly, mortality associated with the disorder remains unacceptably high. Recent treatment guidelines have reinforced the importance of early goal directed therapy. Recently, moderate doses of corticosteroid replacement and activated protein C (drotrecogin alfa[activated]) are the therapies demonstrating efficacy. Extra-corporeal blood purification techniques offer a variety of techniques that can efficiently eliminate septic mediators. The rationale for its use in sepsis is sound Animal and human studies show promise with improvements in hemodynamics and mortality, but are limited by number and design. These techniques require large-scale well-conducted studies to demonstrate the validity in sepsis.
Ratanarat
Ranistha
R
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. ranittha@hotmail.com
Permpikul
Chairat
C
D006440:Hemofiltration; D006464:Hemoperfusion; D006801:Humans; D010956:Plasmapheresis; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000517:prevention & control*