EXTRACORPOREAL ADSORBENT-BASED STRATEGIES IN SEPSIS

Gram-negative bacterial sepsis remains a challenging diagnostic and th erapeutic dilemma to the practicing clinician, Bacterial-derived produ cts leg, gram-negative bacterial lipopolysaccharide or endotoxin) and host inflammatory mediators (eg, tumor necrosis factor-alpha and inter leukin-l) are believed to play a pivotal role in the pathogenesis of s epsis and septic shock. Despite the many advances in the treatment of sepsis, mortality rates in septic patients remain high. Indeed, numero us clinical trials using biologically engineered immunotherapies targe ting specific inflammatory mediators have proven unsuccessful, This la ck of success has led to a renewed interest in blood purification tech niques using extracorporeal therapies. During sepsis, circulating bact erial-derived products as well as inflammatory mediators can be reduce d and/or eliminated by various extracorporeal adjunctive therapies suc h as plasma exchange, continuous renal replacement, and adsorbent-base d therapies, Adsorbents have commonly been used orally for gastrointes tinal removal of toxins or drugs, However, their potential use in seps is has received little attention. The incorporation of adsorbents in h emoperfusion columns has allowed their use for the removal of toxic co mpounds from the circulatory system, Adsorbents developed for use in s epsis can bind toxins in a nonselective leg, charcoal), selective leg, polymyxin B-immobilized polystyrene-derivative fiber), or specific le g, antibody-coated microsphere-based detoxification system) way, Howev er, despite an explosive development in the experimental use of these promising therapies, randomized clinical trials are currently lacking, In summary, a multi-disciplinary complex therapeutic approach remains a prerequisite to the successful treatment of sepsis. (C) 1997 by the National Kidney Foundation, Inc.