Clinical use of plasmafiltration coupled with adsorption
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v1i1.1148
Abstract
Coupled plasma filtration adsorption is an extracorporeal therapy that combines plasma separation and adsorption of inflammatory mediators and toxins, followed by hemofiltration to control volume overload and removal of small and medium-sized water-soluble mediators. Although it is not new, there are still doubts about its clinical role. Evidence indicates that the coupled plasma filtration adsorption is highly efficient in removing inflammatory molecules in sepsis. So far it has not been shown to reduce mortality, but it is possible to achieve a better hemodynamic benefit over convective therapies. On the other hand, the absorptive component makes it possible to purify larger mediators associated with causes of non-septic acute kidney injury, such as myoglobin, toxins associated with liver failure and others, allowing that coupled plasma filtration adsorption indications to be expanded to various clinical settings with a high inflammatory component, particularly when it is required to manage several organ dysfunctions simultaneously.
Keywords
coupled plasma filtration adsorption; detoxification; sepsis; rhabdomyolysis; liver failure
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[12] Tetta C, Cavaillon JM, Schulze M, Ronco C, Ghezzi PM, Camussi G, et al. Removal of Cytokines and Activated Complement Components in an Experimental Model of Continuous Plasma Filtration Coupled with Sorbent Adsorption. Nephrol Dial Transplant. 1998;13(6):1458-64. doi: 10.1093/ndt/13.6.1458.
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[14] Sykora R, Chvojka J, Krouzecky A, Radej J, Kuncova J, Varnerova V, et al. Coupled Plasma Filtration Adsorption in Experimental Peritonitis-Induced Septic Shock. Shock. 2009;31(5):473-80. doi: 10.1097/SHK.0b013e318188dec5.
[15] Bouman CS, Oudemans-van Straaten HM, Schultz MJ, Vroom MB. Hemofiltration in Sepsis and Systemic Inflammatory Response Syndrome: The Role of Dosing and Timing. J Crit Care. 2007;22(1):1-12. doi: 10.1016/j.jcrc.2006.05.002.
[16] Bagshaw SM, Wald R. Strategies for the Optimal Timing to Start Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury. Kidney Int. 2017;91(5):1022-32. doi: 10.1016/j.kint.2016.09.053.
[17] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-77. doi: 10.1007/s00134-017-4683-6.
[18] Lentini P, Cruz D, Nalesso F, de Cal M, Bobek I, Garzotto F, et al. Coupled Plasma Filtration Adsorption (CPFA) Versus Emofiltrazione Continua Con Regime Intermittente Di Alti Volumi (pHAHF) Nel Trattamento Dello Shock Settico: Uno Studio Pilota. G Ital Nefrol. 2009;26(6):695-703.
[19] Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A, et al. A Pilot Study of Coupled Plasma Filtration with Adsorption in Septic Shock. Crit Care Med. 2002;30(6):1250-5. doi:10.1097/00003246-200206000-00015.
[20] Formica M, Olivieri C, Livigni S, Cesano G, Vallero A, Maio M, et al. Hemodynamic Response to Coupled Plasma Filtration-Adsorption in Human Septic Shock. Intensive Care Med. 2003;29(5):703-8. doi: 10.1007/s00134-003- 1724-0.
[21] Berlot G, Agbedjro A, Tomasini A, Bianco F, Gerini U, Viviani M, et al. Effects of the Volume of Processed Plasma on the Outcome, Arterial Pressure and Blood Procalcitonin Levels in Patients with Severe Sepsis and Septic Shock Treated with Coupled Plasma Filtration and Adsorption. Blood Purif. 2014;37(2):146-51. doi:10.1159/000360268.
[22] Hu D, Sun S, Zhu B, Mei Z, Wang L, Zhu S, et al. Effects of Coupled Plasma Filtration Adsorption on Septic Patients with Multiple Organ Dysfunction Syndrome. Ren Fail. 2012;34(7):834-9. doi: 10.3109/0886022X.2012.684553.
[23] Turani F, Falco M, Natoli S, Leonardis F, Fede M, Berlot G, et al. Coupled Plasma Filtration and Adsorption in Septic Shock: A Multicentric Experience. Crit Care. 2010;14(Suppl. 1):P412. doi: 10.1186/cc8644.
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