脓毒症和感染性休克的体外血液净化策略:对最近进展的洞察。

Yatin Mehta, Rajib Paul, Abdul Samad Ansari, Tanmay Banerjee, Serdar Gunaydin, Amir Ahmad Nassiri, Federico Pappalardo, Vedran Premužić, Prachee Sathe, Vinod Singh, Emilio Rey Vela
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引用次数: 1

摘要

背景:尽管有多种治疗败血症的方法,但它是全球重症监护病房患者死亡的主要原因之一。对脓毒症病理生理学的了解激发了人们对体外疗法(ECT)的兴趣,这种疗法旨在通过去除过量的炎症介质来平衡免疫系统的失调。目的:回顾电痉挛治疗败血症的最新数据,并评估其对各种炎症和临床结果的影响。方法:在本综述中,广泛的英文文献检索进行了从过去二十年来确定使用电痉挛治疗败血症。共选择了同行评审和索引期刊的68篇文章,不包括只有摘要的出版物。结果:结果显示ECT技术,如大容量血液过滤、耦合血浆吸附/过滤、树脂或聚合物吸附剂和CytoSorb®正在成为改善脓毒症血液动力学稳定性的辅助疗法。CytoSorb®在脓毒性休克领域的使用方面发表的数据最多,有提高生存率和降低顺序器官衰竭评估评分、乳酸水平、总白细胞计数、血小板计数、白细胞介素- IL-6、IL-10和TNF水平的报告。结论:由于缺乏大规模随机临床试验,目前临床对ECT治疗脓毒症和感染性休克的接受程度仍然有限。除了针对患者的治疗外,未来的研究还将针对免疫反应的细胞水平进行开发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements.

Background: Despite various therapies to treat sepsis, it is one of the leading causes of mortality in the intensive care unit patients globally. Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies (ECT) which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators.

Aim: To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes.

Methods: In this review, an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis. A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts.

Results: Results showed that ECT techniques such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, and CytoSorb® are emerging as adjunct therapies to improve hemodynamic stability in sepsis. CytoSorb® has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores, lactate levels, total leucocyte count, platelet count, interleukin- IL-6, IL-10, and TNF levels.

Conclusion: Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials. In addition to patient-tailored therapies, future research developments with therapies targeting the cellular level of the immune response are expected.

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