Cytokine removal in human septic shock: Where are we and where are we going?

Annals of Intensive Care

Lui G. Forni¹  Zsolt Molnár²  Patrick M. Honore³  Olivier Joannes-Boyau⁴  Eric Hoste⁵  Rita Jacobs⁶  Manu L. N. G. Malbrain⁷ 

[1] 0000 0001 0372 6120, grid.412946.c, Department of Critical Care, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK;0000 0004 0407 4824, grid.5475.3, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK;0000 0001 1016 9625, grid.9008.1, Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary;0000 0004 0469 8354, grid.411371.1, Intensive Care Department, CHU Brugmann University Hospital, 4, Place Arthur Van Gehuchtenplein, 1020, Brussels, Belgium;0000 0004 0593 7118, grid.42399.35, Département d’Anesthésie-Réanimation SUD, CHU Bordeaux, 33000, Bordeaux, France;0000 0004 0626 3303, grid.410566.0, Intensive Care Department, Ghent University Hospital, Ghent, Belgium;0000 0004 0626 3362, grid.411326.3, Intensive Care Department, University Hospital Brussels (UZB), Jette, Belgium;0000 0004 0626 3362, grid.411326.3, Intensive Care Department, University Hospital Brussels (UZB), Jette, Belgium;0000 0001 2290 8069, grid.8767.e, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium;

关键词: Blood purification;    Cytokines;    Sepsis;    Septic shock;    Haemoperfusion;    Cytosorb;    Sorbents;    Cartridges;    Immune modulation;    DAMPS;    PAMPS;   

DOI  :  10.1186/s13613-019-0530-y

来源: publisher

【 摘 要 】

Although improving, the mortality from septic shock still remains high despite increased international awareness. As a consequence, much effort has focused on alternative treatment strategies in an effort to improve outcomes. The application of blood purification therapies to improve immune homeostasis has been suggested as one such method, but these approaches, such as high-volume continuous haemofiltration or cytokine and/or endotoxin removal, have enjoyed little success to date. More recently, the use of sorbent technologies has attracted much attention. These adsorbers are highly effective at removing inflammatory mediators, in particular, cytokines, from the bloodstream. This narrative review is the executive summary of meetings held throughout the 6th International Fluid Academy Days in Antwerp, Belgium (Nov 23–25, 2017), focusing on the current understanding regarding the use of such adsorbers in humans with septic shock. We followed a modified Delphi approach involving a combination of evidence appraisal together with expert opinion in order to achieve recommendations for practice and, importantly, future research.

【 授权许可】

CC BY