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    Plasmapheresis for streptococcal sepsis? Drenger B,Israeli A,Or R,Leitersdorf E Lancet (London, England) 10.1016/s0140-6736(85)90870-0
    A role for plasma removal during sepsis? Grooteman M P,Groeneveld A B Intensive care medicine
    Multiple organ failure--a role for plasma exchange? McClelland P,Williams P S,Yaqoob M,Mostafa S M,Bone J M Intensive care medicine Two patients with multiple organ failure, septicaemia and a deteriorating clinical course were treated by plasma exchange in addition to standard supportive measures. Dramatic improvements were seen in cardio-respiratory (patient 1), neurological and renal parameters (patient 2) which were attributable to the exchanges. Plasma exchange might be of value as adjunctive therapy where overwhelming septicaemia occurs with multiple organ failure.
    Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial. Busund Rolf,Koukline Vladimir,Utrobin Uri,Nedashkovsky Edvard Intensive care medicine OBJECTIVE:To determine the therapeutic efficacy and safety of plasmapheresis in the treatment of patients with severe sepsis and septic shock. DESIGN:Prospective, randomised, clinical trial with a planned, midstudy, interim analysis. SETTING:Intensive care unit in a university hospital in Archangels, Russia. PATIENTS:Consecutive patients with severe sepsis or septic shock. INTERVENTIONS:One hundred and six patients were randomised to receive either standard therapy or an add-on treatment with plasmapheresis. MEASUREMENTS AND RESULTS:The primary endpoint was 28-day survival. Septic shock was diagnosed in 57% of the plasmapheresis-treated patients and 54% of the control patients. Mean APACHE III score at entry was 56.4 in the plasmapheresis group and 53.5 in the control group. The 28-day, all-cause mortality rate was 33.3% (18/54) in the plasmapheresis group and 53.8% (28/52) in the control group. This represents a relative risk for fatal outcome in the plasmapheresis group of 0.61, an absolute risk reduction of 20.5% and a number of patients needed to treat of 4.9. Apart from six transient episodes of hypotension and one allergic reaction to fresh frozen plasma, no adverse reactions were attributable to the plasmapheresis treatment in this study. CONCLUSIONS:Plasmapheresis may be an important adjuvant to conventional treatment to reduce mortality in patients with severe sepsis or septic shock. Plasmapheresis is a safe procedure in the treatment of septic patients. A prospective randomised multicentre trial is warranted to confirm our results and to determine which subgroups of septic patients will benefit most from this treatment modality. 10.1007/s00134-002-1410-7
    Coupled plasma filtration adsorption. Bellomo Rinaldo,Tetta Ciro,Ronco Claudio Intensive care medicine BACKGROUND:Severe sepsis and septic shock are perhaps the major cause of morbidity and mortality in Intensive Care. Their pathogenesis is only partly understood. Circulating peptides and lipid-derived substances (so-called mediators), however, appear to participate in the development of organ dysfunction. It might be possible to treat plasma in such a way that the injurious effect of mediators can be attenuated. INVESTIGATIONS:Several ex vivo studies have shown that it is technically possible to adsorb mediators by means of specially developed sorbents. The application of these sorbents to the treatment of plasma in animals with experimental sepsis has shown that several markers of inflammation can be attenuated and that animal survival can be increased. We have recently transferred such technology to the treatment of human septic shock using a technique called Coupled Plasma Filtration Adsorption (CPFA). CPFA was found to attenuate the hypotension of septic shock and to dramatically alter the immuno-paralytic toxicity of septic plasma. Monocytes of patients treated with CPFA underwent a major improvement in their ability to respond to endotoxin. CONCLUSIONS:CPFA represents a promising new approach to blood purification in sepsis. The findings associated with its application to humans highlight the importance of continuing to investigate blood purification as a possible approach to the treatment of septic shock, the potential usefulness of the humoral theory of sepsis, and the dominant state of immunosuppression associated with established septic shock. 10.1007/s00134-003-1796-x
    Is there a role for plasmapheresis/plasma exchange therapy in septic shock, MODS, and thrombocytopenia-associated multiple organ failure? We still do not know--but perhaps we are closer. Carcillo Joseph A,Kellum John A Intensive care medicine 10.1007/s00134-002-1428-x