Surviving Sepsis Campaignからみたアフェレシス(<特集>敗血症とアフェレシス)

概要

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Continuous Hemodiafiltration (CHDF) is recommended for hemodynamically unstable patients with sepsis-induced acute renal failure in Surviving Sepsis Campaign Guideline (SSCG). On the other hand, although essential to sepsis is hypercytokinemia, apheresis therapy as the anti-cytokine therapy is not mentioned in SSCG. A recent paper reported that continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter continuous venovenous hemodiafiltration (PMMA-CVVHDF) was effective for removing cytokines and enabled a wide range of clinical efficacy through cytokine modulation. PMMA-CVVHDF has been reported to be effective for cytokine removal therapy. Furthermore, our previous paper suggested that PMMA-CVVHDF was more effective than polyacrylonitrile membrane hemofilter (PAN)-CVVHDF for the treatment of patients with septic shock based on the improvements in many cytokines. In the PMMA-CVVHDF group, the lactic acid value at 3 days after CVVHDF was significantly better than the values before and 1 day after CVVHDF. In contrast, the lactic acid values obtained before and 1 and 3 days after treatment showed no significant improvements in the PAN-CVVHDF and non-CVVHDF groups. And the outcome of the PMMA-CVVHDF group was significantly better than that of the PAN-CVVHDF group or the non-CVVHDF group.
2012-05-31