H.E.L.P. in Gram-negative, Refractory Septic Shock: First Clinical Experiences.(Workshop1-12)

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概要

• 論文の詳細を見る

• H.E.L.P. (heparin-induced extracorporeal lipoprotein-fibrinogen precipitation) is an established procedure for extracorporeal treatment of severe hypercholesterolemia. Recently, an in-vitro re-evaluation of this method revealed that not only low-density lipoprotein (LDL), lipoprotein (a) and fibrinogen, but also lipopolysaccharides (LPS; endotoxin), tumor necrosis factor a (TNF-a) and C-reactive protein (CRP) are removed from plasma. As LPS and TNF-a are involved in the pathogenesis and progression of sepsis we performed in a pilot study nine treatments in four cases with LPS-induced refractory septic shock. Extracorporeal treatments were performed in the standard H.E.L.P. mode (N = 6) or in a modified mode without addition of the precipitating agent heparin (N = 3). On average 3.245 L of plasma was processed during each session. All treatments were tolerated very well. Observed percent reduction of plasma constituents were (mean value; standard/modified procedure): LPS, 49.7/57.2; TNF-a, 24.6/4.5; CRP, 49.4/54.8;Fibrinogen, 49.4/5.7; total cholesterol, 37.8/4.7; ApoB, 40.6/2.0. Despite all therapeutic efforts, outcome however, was poor: one patient survived, three patients died 5, 16 and 33 days, respectively, after the last H.E.L.P. treatment. H.E.L.P. performed in the standard mode removes both LPS and TNF-a without eliminating substances necessary for the endogenous clearance of LPS (e.g., high-density lipoprotein). The advantage of this procedure is that it is aimed not only at a single target of the sepsis cascade. Further clinical evaluation will focus on amount of plasma volume processed, optimal time to initiate treatment as well as treatment intervalls.

• 日本アフェレシス学会の論文

著者

• Boos Karl-siegfried

  Institut Fur Klinische Chemie Klinikum Groβhadern Der Ludwig-maximilians-universitat

• Arendt Rainer

  Medical Clinic I.

• Haller Mathias

  Institute of Anesthesiology, University Hospital MunichGrosshadern

• Samtleben Walter

  Medical Clinic I.

• Fraunberger Peter

  Institute of Clinical Chemistry

• Briegel Josef

  Institute of Anesthesiology, University Hospital MunichGrosshadern

• Peter Klaus

  Institute of Anesthesiology, University Hospital MunichGrosshadern

• Seidel Dieter

  Institute of Clinical Chemistry

• Boos Karl-Siegfried

  Institute of Clinical Chemistry

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• H.E.L.P. in Gram-negative, Refractory Septic Shock: First Clinical Experiences.(Workshop1-12)

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