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The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report

Sepsis and septic shock are major healthcare problems, resulting in high morbidity and mortality. The Surviving Sepsis Campaign (SSC), which standardised the approach to sepsis, was recently updated. Strategies to decrease the systemic inflammatory response have been proposed to modulate organ dysfu...

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Autores principales: Hadade, Adina N., Breazu, Caius M., Ilie, Iulian V., Mitre, Calin I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: De Gruyter Open 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769914/
https://www.ncbi.nlm.nih.gov/pubmed/29967875
http://dx.doi.org/10.1515/jccm-2017-0010
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author Hadade, Adina N.
Breazu, Caius M.
Ilie, Iulian V.
Mitre, Calin I.
author_facet Hadade, Adina N.
Breazu, Caius M.
Ilie, Iulian V.
Mitre, Calin I.
author_sort Hadade, Adina N.
collection PubMed
description Sepsis and septic shock are major healthcare problems, resulting in high morbidity and mortality. The Surviving Sepsis Campaign (SSC), which standardised the approach to sepsis, was recently updated. Strategies to decrease the systemic inflammatory response have been proposed to modulate organ dysfunctions. Endotoxin, derived from the membrane of Gram-negative bacteria, is considered a major factor in the pathogenesis of sepsis. Endotoxin adsorption, if effective, has the potential to reduce the biological cascade of Gram-negative sepsis. We present a case of a 64-year-old man with severe Gram-negative sepsis, following purulent peritonitis secondary to rectosigmoid adenocarcinoma. To reduce the amplitude of the general effects of endotoxins we used a novel device, the Alteco® LPS Adsorber (Alteco Medical AB, Lund, Sweden), for lipopolysaccharide (LPS) adsorption. The efficacy markers were: the overall haemodynamic profile, translated into decreased vasopressor requirements, the normalisation of the cardiac index, the systemic vascular resistance index combined with the lactate level and the reduction in procalcitonin (PCT) levels. A decrease in the sequential organ failure assessment (SOFA) score at twenty-four hours was demonstrated. The clinical course following treatment was favourable for the days immediately following the treatment.This was attributed to the removal of endotoxin from the systemic circulation. The patient died one week after the endotoxin removal session, developing an ischemic bowel perforation with subsequent multiple organ failures.
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spelling pubmed-57699142018-07-02 The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report Hadade, Adina N. Breazu, Caius M. Ilie, Iulian V. Mitre, Calin I. J Crit Care Med (Targu Mures) Case Report Sepsis and septic shock are major healthcare problems, resulting in high morbidity and mortality. The Surviving Sepsis Campaign (SSC), which standardised the approach to sepsis, was recently updated. Strategies to decrease the systemic inflammatory response have been proposed to modulate organ dysfunctions. Endotoxin, derived from the membrane of Gram-negative bacteria, is considered a major factor in the pathogenesis of sepsis. Endotoxin adsorption, if effective, has the potential to reduce the biological cascade of Gram-negative sepsis. We present a case of a 64-year-old man with severe Gram-negative sepsis, following purulent peritonitis secondary to rectosigmoid adenocarcinoma. To reduce the amplitude of the general effects of endotoxins we used a novel device, the Alteco® LPS Adsorber (Alteco Medical AB, Lund, Sweden), for lipopolysaccharide (LPS) adsorption. The efficacy markers were: the overall haemodynamic profile, translated into decreased vasopressor requirements, the normalisation of the cardiac index, the systemic vascular resistance index combined with the lactate level and the reduction in procalcitonin (PCT) levels. A decrease in the sequential organ failure assessment (SOFA) score at twenty-four hours was demonstrated. The clinical course following treatment was favourable for the days immediately following the treatment.This was attributed to the removal of endotoxin from the systemic circulation. The patient died one week after the endotoxin removal session, developing an ischemic bowel perforation with subsequent multiple organ failures. De Gruyter Open 2017-05-11 /pmc/articles/PMC5769914/ /pubmed/29967875 http://dx.doi.org/10.1515/jccm-2017-0010 Text en © 2017 Walter De Gruyter GmbH, Berlin/Boston http://creativecommons.org/licenses/by-nc-nd/4.0 This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
spellingShingle Case Report
Hadade, Adina N.
Breazu, Caius M.
Ilie, Iulian V.
Mitre, Calin I.
The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report
title The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report
title_full The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report
title_fullStr The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report
title_full_unstemmed The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report
title_short The Use of Endotoxin Adsorption in Extracorporeal Blood Purification Techniques. A Case Report
title_sort use of endotoxin adsorption in extracorporeal blood purification techniques. a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769914/
https://www.ncbi.nlm.nih.gov/pubmed/29967875
http://dx.doi.org/10.1515/jccm-2017-0010
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