Efficacy of an extracorporeal endotoxin adsorber system during hyperdynamic porcine endotoxemia.
BACKGROUND
Endotoxemia is a crucial factor in the pathogenesis of sepsis. Elimination of endotoxin is aimed at the reduction of sepsis-related morbidity and lethality. The objective of this study was to examine the impact of an endotoxin adsorber on hemodynamics, O(2) exchange and metabolism during resuscitated porcine endotoxemia.


METHODS
Twenty pigs were randomized into 2 intervention groups (n = 7 each) and 1 control group (n = 6). Endotoxemia was induced by continuous intravenous application of lipopolysaccharide for 8 h. Adsorber therapy was started at the same time as the induction of endotoxemia or 2 h later. An extracorporeal hemoperfusion device using immobilized human serum albumin for endotoxin adsorption was used.


RESULTS
Hemodynamic, metabolic and acid-base parameters, as well as the kinetics of interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor-alpha, were characteristic for endotoxic shock. Endotoxin plasma levels were low (arterial, hepatic and portal vein). None of the parameters were significantly influenced by the adsorber system.


CONCLUSIONS
Despite typical clinical signs of endotoxemia, the adsorber system had no significant effect on hemodynamic, metabolic and acid-base parameters during endotoxic shock. The reasons for the absence of an effect are elusive; however, failure of the method per se or exceeded capacity of the adsorber cannot be excluded.
Bracht
H
H
Sektion Anasthesiologische Pathophysiologie und Verfahrensentwicklung, Universitatsklinikum, Parkstrasse 11, Ulm, Germany. hendrik.bracht@uniklinik-ulm.de
Hauser
B
B
Ivanyi
Z
Z
Asfar
P
P
Ehrmann
U
U
Brueckner
U B
UB
Georgieff
M
M
Radermacher
P
P
Buttenschon
K
K
D000327:Adsorption; D000818:Animals; D019446:Endotoxemia / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D004731:Endotoxins / Q000097:blood / Q000378:metabolism*; D005260:Female; D006439:Hemodynamics; D006464:Hemoperfusion; D006801:Humans; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D010100:Oxygen / Q000378:metabolism; D013552:Swine; D013997:Time Factors
D004731:Endotoxins; D008070:Lipopolysaccharides; D010100:Oxygen