PLASMAPHERESIS IN A 62-YEAR-OLD MALE-PATI ENT WITH SEVERE SEPSIS

Introduction: The elimination of cytotoxic substances from blood as pa rt of sepsis treatment has been controversely discussed so far. The fo llowing case report demonstrates the advantages and disadvantages of t his therapy strategy. Case Report: A 62-year-old male patient develope d a paralytic ileus with wound dissection 3 days after elective sigma resection. A few hours after surgical revision he went into severe sep sis. A controlled ventilation was necessary as well as the use of cate cholamines to maintain sufficient mean arterial pressure. Body tempera ture stayed between 39 and 40 degrees C (rectal). The patient's extrem ities and body showed severe marmorations due to the pathologic vasal alteration. A laparotomy one day after the operation revealed a massiv e generalized edema of the bowels without any evidence of insufficient anastomosis, The fulminant septic process could not be stopped with c onservative treatment including continuous veno-venous hemofiltration. Under further deterioration of the pulmonary function (signs of begin ning ARDS) and the generalized capillary leak syndrome we started plas mapheresis 2 days after operation in order to eliminate high-molecular cytokines. The plasmapheresis was done twice the following 2 days. Un der this treatment the septic process was stopped. The pulmonary funct ion and the circulation improved, The disturbed peripheral perfusion n ormalized. A laparotomy confirmed a significant decrease of the intest ine wall edema. Unfortunately we could not repeat plasmapheresis. On t he following days the patient worsened again and died 20 days later du e to multiorgan failure. Discussion: The temporary improvement during plasmapheresis suggests that the patient might have profited from plas mapheresis-related optimized oxygen delivery, controlled diuresis and decrease of oxygen consumption. In addition we hypothesized that elimi nation of high-molecular cytokines and toxines contributed to the impr ovement under plasmapheresis, Using plasmapheresis one has to consider the high costs, risk of infection, and the unexplained mode of action to the mediatory process. Therefore we cannot recommend this treatmen t in general. Further controlled studies should investigate the therap eutic benefits of plasmapheresis in patients with severe sepsis.