Satoh Kasumi, Okuyama Manabu, Irie Yasuhito, Kitamura Toshiharu, Nakae Hajime
Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine, Akita, JPN.
Cureus. 2021 Jan 5;13(1):e12495. doi: 10.7759/cureus.12495.
Sepsis is associated with life-threatening organ dysfunction. Drastic treatment methods such as antimicrobials and surgical control have been used to manage sepsis. However, there are currently no other sepsis-specific treatments capable of improving mortality rates. Plasma exchange (PE) for the removal of toxic substances and the replacement of consumed bioprotective proteins has been advocated as a potential treatment for sepsis. Although the evidence for the efficacy of PE for sepsis is quite limited, in a recent finding, sepsis patients treated with PE showed improvement in fluid balance and organ damage. Continuous PE with dialysis (cPED), which is a modified version of PE, is a novel blood purification method. cPED is a combination of selective PE and hemodialysis and operates slowly in a simple circuit that can potentially provide powerful supportive care for patients with multiple organ failure. In this report, we present two cases of treatment with cPED in patients with severe sepsis and organ damage. Both patients were discharged alive without any adverse events from cPED. cPED improved fluid balance as well as laboratory parameters that had reflected multiple organ failure. This suggests a possible reduction in side effects such as leakage of bio-essential proteins and citric acid reactions to large doses of fresh frozen plasma. The clinical course of these two patients may be useful for setting outcomes in future clinical studies regarding the effectiveness of cPED for severe sepsis.
脓毒症与危及生命的器官功能障碍相关。抗菌药物和手术控制等激进的治疗方法已被用于治疗脓毒症。然而，目前尚无其他能够提高死亡率的脓毒症特异性治疗方法。血浆置换（PE）用于清除有毒物质和补充消耗的生物保护蛋白，已被提倡作为脓毒症的一种潜在治疗方法。尽管PE治疗脓毒症疗效的证据相当有限，但最近的一项研究发现，接受PE治疗的脓毒症患者在液体平衡和器官损伤方面有所改善。连续性血浆滤过透析（cPED）是PE的改良版本，是一种新型血液净化方法。cPED是选择性PE和血液透析的结合，在一个简单的回路中缓慢运行，有可能为多器官功能衰竭患者提供强有力的支持治疗。在本报告中，我们介绍了两例严重脓毒症和器官损伤患者接受cPED治疗的病例。两名患者均存活出院，cPED未引发任何不良事件。cPED改善了液体平衡以及反映多器官功能衰竭的实验室指标。这表明可能减少诸如生物必需蛋白渗漏和对大剂量新鲜冰冻血浆的柠檬酸反应等副作用。这两名患者的临床病程可能有助于确定未来关于cPED治疗严重脓毒症有效性的临床研究的结果。
