Extracorporeal treatments in sepsis: Are there new perspectives?

C. Tetta, V. D'Intini, R. Bellomo, M. Bonello, V. Bordoni, Z. Ricci, C. Ronco

Research output: Contribution to journalArticle

Abstract

Sepsis continues to provide a major challenge to clinicians. Despite vast advancements achieved in the understanding of its pathways and mechanisms, the incidence of sepsis is increasing and the mortality and morbidity rates remain high, generating a considerable burden to health budgets worldwide. Unfortunately, no definitive therapy yet exists that can successfully treat sepsis and its complications. At variance with targeting single mediators, therapeutic intervention aimed at the non-selective removal of pro- and anti-inflammatory mediators seems a rational concept and a possible key to successful extra-corporeal therapies. A further advantage may lie in the continuous nature of such therapy. With such continuous therapy, sequentially appearing peaks of systemic mediator overflow may be attenuated and persistently high plasma levels reduced. This theoretical framework is proposed as the underlying biological rationale for a series of innovative modalities in sepsis. In this editorial, we will review recent animal and human trials which lend support to this concept. We will also review the importance of treatment dose during continuous renal replacement therapy as a major factor affecting survival in critically ill patients with acute renal failure. We will also review novel information related to other blood purification techniques using largo pore membranes or plasma filtration with adsorbent perfusion. Although these approaches are still in the early stages of clinical testing, they are conceptually promising and might represent an important advance.

Original languageEnglish
Pages (from-to)299-304
Number of pages6
JournalClinical Nephrology
Volume60
Issue number5
Publication statusPublished - Nov 2003

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Keywords

  • Acute renal failure
  • Blood purification therapy
  • Extracorporeal treatment
  • Hemostasis
  • Sepsis

ASJC Scopus subject areas

  • Nephrology

Cite this

Tetta, C., D'Intini, V., Bellomo, R., Bonello, M., Bordoni, V., Ricci, Z., & Ronco, C. (2003). Extracorporeal treatments in sepsis: Are there new perspectives? Clinical Nephrology, 60(5), 299-304.