Plasmafiltration in septic shock: a review of 15 cases
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KeywordsNoradrenaline Adrenaline Septic Shock Peritonitis Organ Dysfunction
Plasmafiltration is a nonselective method with the potential of removing harmful mediators, and is being used as salvage therapy and suggested to play an important role in severe infection. This study aims to evaluate efficacy and safety of plasmafiltration used as salvage therapy in septic shock in our ICU.
This study enrolled 15 adult patients admitted from January 1998 to December 2000 to our eight-bed mixed-case ICU of a tertiary care hospital, with septic shock refractory to conventional therapy. A plasmafiltration session with albumin-electrolyte replacement solution was initiated for each patient. Demographic and clinical data were collected from clinical registries. Variables such as systolic pressure, inotropes, oxygen saturation, oxygen inspiration fraction, PEEP, platelets, and coagulation were collected before plasmafiltration and 6 and 24 hours after. SPSS for Windows was used for data analysis.
From the 15 patients enrolled, 47% were male and mean age was 53 years; mean APACHE II was 25. Pneumonia was the primary infection in 40% of patients; peritonitis in 20%. All patients were under adrenaline or noradrenaline infusion. Twenty-seven per cent experienced minor hemorrhagic complications during plasmafiltration; no fatal complications were attributed to plasmafiltration. A trend towards lowering inotrope dose was noticed, without statistic significance. Thirty-three per cent of patients recovered and were discharged alive from the ICU.
Plasmafiltration seems to have an important role in septic shock, delaying the process of organ dysfunction and allowing treatment of the underlying cause. Moreover, it is a safe procedure. Further investigation is still needed on this subject.