Rationale of Extracorporeal Removal of Endotoxin in Sepsis: Theory, Timing and Technique
Rationale of Extracorporeal Removal of Endotoxin in Sepsis: Theory, Timing and Technique
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DOI：
10.1159/000315916
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发表时间：
2010-01-01
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影响因子：
--
通讯作者：
Kellum, John
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作者：
Ronco, Claudio;Piccinni, Pasquale;Kellum, John
脓毒症的一些体征和症状是由于循环中存在内毒素造成的。在动物和人类模型中，对内毒素损伤都有明显的免疫反应。此外，心血管功能改变、肺功能障碍和急性肾损伤在脓毒症和内毒素血症中很常见。在这些情况下，在早期阶段识别脓毒症患者并表征与之相关的体液改变（包括循环内毒素的识别和定量）极其重要。一旦获得这一点，尝试去除尽可能多的循环内毒素以减轻这种情况的临床影响似乎是合乎逻辑的。今天，这可以通过在体外回路中使用带有固定多粘菌素 B 的盒的非常特殊的血液灌流过程来实现。这种方法似乎可以显着去除内毒素，并显着降低其循环水平。这种方法的临床效果可以概括为早期阶段脓毒症级联反应的缓解，以及结果的改善。最近的临床结果似乎证实了这些预期，显示由于近期手术而出现腹部脓毒症早期症状的患者死亡率降低，这为脓毒症干预开辟了新途径。版权所有 (C) 2010 S Karger AG，巴塞尔
Several signs and symptoms in sepsis are due to the presence of endotoxin in the circulation. Both in animal and human models, there is an evident immunological response to the endotoxin insult Furthermore, altered cardiovascular function, lung dysfunction and acute kidney injury are common in sepsis and endotoxemia. In these circumstances it would be extremely important to identify patients with sepsis in the early phases and to characterize the humoral alterations involved with it, including the identification and quantification of circulating endotoxin. Once this is obtained, it seems logical to try to remove as much of the circulating endotoxin as possible in order to mitigate the clinical effects of this condition This can be achieved today with a very specific hemoperfusion process utilizing cartridges with immobilized polymixin B in an extracorporeal circuit. This approach seems to provide a significant removal of endotoxin with a significant reduction of its circulating levels. The clinical consequences of this approach can be summarized in a mitigation of the septic cascade in the early phases, with improvement of outcome Recent clinical results seem to confirm these expectations showing a reduction of mortality in patients with early signs of abdominal sepsis due to recent surgery This opens a new avenue for intervention in sepsis. Copyright (C) 2010 S Karger AG, Basel