Apheresis of plasma compounds as a therapeutic principle in severe sepsis and multiorgan dysfunction syndrome

During sepsis there is an increase in the plasma content of several compoun ds, e.g., bacterial toxins, cytokines, cell debris, free hemoglobin and myo globin. In blood, these compounds activate various cascade systems, which i n large amounts or in more vulnerable patients lead to a disseminated intra -vascular coagulopathy (DIC) with multiorgan dysfunction syndrome (MODS) an d death, despite conventional intensive? care unit therapy. Therapeutic att empts to reverse these conditions have so far been of limited benefit. Thes e effects have mainly been focused on lowering the blood concentration of s ingle substances such as tumor necrosis factor. By the use of low-and high-flux hemodialysis filters, usually only small am ounts of these substances are removed. By the use of plasmapheresis or plas ma exchange, the extent of removal is considerably increased. The efficacy varies between the techniques (centrifugation vs. filtration or adsorption) and has also different influences on e.g. the complement system. This repo rt describes these techniques and the therapeutical possibilities given by them. In small trials, blood or plasma exchange has been used as rescue the rapy in critically ill patients with a progressive MODS and DIG. A survival of about 80 % of the patients has been reported in these studies and the u se of combined therapy will be discussed. Controlled trials are required in this field.