Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France,
EA 7426, PI3 (Pathophysiology of Injury‑Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France,
Blood Purif. 2019;47 Suppl 3:1-14. doi: 10.1159/000499520. Epub 2019 Apr 11.
Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club "Cappuccino with Claudio Ronco" at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52.
体外血液净化被提议作为脓毒症的辅助治疗方法，旨在控制与之相关的免疫系统失调，因为免疫系统失调会导致器官功能障碍。已经开发出不同的疗法来解决免疫失调的某些步骤。大多数可用的血液净化设备都专注于单一目标，例如触发免疫级联反应的内毒素，或导致器官损伤的细胞因子风暴。然而，名为 oXiris®的高吸附性膜是一种独特的 4-in-1 设备，结合了细胞因子和内毒素去除特性、肾脏替代功能和抗血栓形成特性。最近，已经开发出针对病原体本身或免疫细胞的有前途的治疗方法，并正在进行研究。在这篇综述中，我们旨在根据其目标，总结已经可用于治疗的不同体外血液净化技术。我们还将简要介绍仍在开发中的最新技术。由于其独特的去除内毒素和细胞因子的能力，我们将特别讨论肝素预吸附的 oXiris®膜。我们将根据实验和临床数据介绍其特性、优点、陷阱以及治疗前景。视频期刊俱乐部“克劳迪奥·罗恩科的卡布奇诺”在 https://www.karger.com/Journal/ArticleNews/223997?sponsor=52.
