Treatment of septic patients with an arginine-based endotoxin adsorber column improves hemodynamics and reduces oxidative stress: results of a feasibility study.
BACKGROUND
Mortality of severe sepsis and septic shock is unacceptably high. Adsorptive removal of endotoxin may interrupt the inflammatory cascade triggered by lipopolysaccharide.


METHODS
Prospective feasibility study with plasma separation and adsorption (PSA) treatment using a novel arginine-coated adsorber column was performed in a tertiary care gastroenterological intensive care unit.


RESULTS
10 patients with severe sepsis/septic shock (median APACHE II score: 27, hospital mortality 40%) were treated with PSA on 5 consecutive days. There were no serious adverse events. No patient died during the treatment period. During treatment sessions, mean arterial pressure and cardiac power index increased while vasopressors could be reduced. Advanced oxidation protein products and in vitro pro- apoptotic activity of plasma decreased. We could not demonstrate any changes in endotoxin levels.


CONCLUSIONS
PSA resulted in a reduction of indicators of oxidative stress and pro-apoptotic activity of the plasma and an improvement in hemodynamic parameters, suggesting increased myocardial contractility and reduced septic vasodilation.
Umgelter
Andreas
A
II. Medizinische Klinik und Poliklinik der Technischen Universitat Munchen, Munchen, Germany. andreas.umgelter@lrz.tu-muenchen.de
Reindl
Wolfgang
W
Lutz
Jens
J
Kreymann
Bernhard
B
Ronco
Claudio
C
Huber
Wolfgang
W
Frank
Helga
H
Schmid
Roland M
RM
Heemann
Uwe
U
D000328:Adult; D000368:Aged; D017209:Apoptosis; D001120:Arginine / Q000627:therapeutic use*; D001794:Blood Pressure; D002302:Cardiac Output; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006464:Hemoperfusion / Q000295:instrumentation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008070:Lipopolysaccharides / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic; D014661:Vasoconstriction
D008070:Lipopolysaccharides; D001120:Arginine