Article ; Online: Rationale for sequential extracorporeal therapy (SET) in sepsis.
Critical care (London, England)
2023 Volume 27, Issue 1, Page(s) 50
Abstract: Sepsis and septic shock remain drivers for morbidity and mortality in critical illness. The clinical picture of patients presenting with these syndromes evolves rapidly and may be characterised by: (a) microbial host invasion, (b) establishment of an ... ...
| Abstract | Sepsis and septic shock remain drivers for morbidity and mortality in critical illness. The clinical picture of patients presenting with these syndromes evolves rapidly and may be characterised by: (a) microbial host invasion, (b) establishment of an infection focus, (c) opsonisation of bacterial products (e.g. lipopolysaccharide), (d) recognition of pathogens resulting in an immune response, (e) cellular and humoral effects of circulating pathogen and pathogen products, (f) immunodysregulation and endocrine effects of cytokines, (g) endothelial and organ damage, and (h) organ crosstalk and multiple organ dysfunction. Each step may be a potential target for a specific therapeutic approach. At various stages, extracorporeal therapies may target circulating molecules for removal. In sequence, we could consider: (a) pathogen removal from the circulation with affinity binders and cartridges (specific), (b) circulating endotoxin removal by haemoperfusion with polymyxin B adsorbers (specific), (c) cytokine removal by haemoperfusion with sorbent cartridges or adsorbing membranes (non-specific), (d) extracorporeal organ support with different techniques for respiratory and cardiac support (CO |
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| MeSH term(s) | Humans ; Endotoxins ; Hemoperfusion/methods ; Polymyxin B/therapeutic use ; Sepsis/therapy ; Shock, Septic/therapy ; Extracorporeal Membrane Oxygenation |
| Chemical Substances | Endotoxins ; Polymyxin B (J2VZ07J96K) |
| Language | English |
| Publishing date | 2023-02-07 |
| Publishing country | England |
| Document type | Journal Article ; Review |
| ZDB-ID | 2041406-7 |
| ISSN | 1466-609X ; 1364-8535 |
| ISSN (online) | 1466-609X |
| ISSN | 1364-8535 |
| DOI | 10.1186/s13054-023-04310-2 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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