Risposta infiammatoriaRisposta infiammatoria- Dove siamo? -- Dove siamo? -

InfectionInfection SepsisSepsis Severe SepsisSevere Sepsis MODSMODS DeathDeath

SIRS = SIRS = Systemic inflammatory response Systemic inflammatory response syndromesyndrome

CARS = CARS = Compensatory anti-inflammatoryCompensatory anti-inflammatoryresponse syndromeresponse syndrome

Hyper-inflammationHyper-inflammation

NormalNormal

ImmunoparalysisImmunoparalysis

““propro””““mixedmixed””

““antianti””

Int J Artif Organ 2002; 25: 733-47Int J Artif Organ 2002; 25: 733-47

Volume 355:1018-1028Volume 355:1018-1028           September 7, 2006           Number 10Number 10

Volume 355:1018-1028Volume 355:1018-1028           September 7, 2006           Number 10Number 10

Volume 355:1018-1028Volume 355:1018-1028           September 7, 2006           Number 10Number 10

RISPOSTA PRO E ANTI-INFIAMMATORIARISPOSTA PRO E ANTI-INFIAMMATORIARISPOSTA PRO E ANTI-INFIAMMATORIARISPOSTA PRO E ANTI-INFIAMMATORIAC

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Peak concentration hypotesis RONCO et allPeak concentration hypotesis RONCO et all

L+ 5/19 L+ 5/19 ((25%25%))

R+ 16/20 R+ 16/20 ((80%80%))

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Coupled Plasma Filtration AdsorptionCoupled Plasma Filtration AdsorptionModello dello shock setticoModello dello shock settico

Tetta C et al. Crit Care Med 2000; 28: 1526-33Tetta C et al. Crit Care Med 2000; 28: 1526-33

Miglioramento della sopravvivenza senza Miglioramento della sopravvivenza senza correlazione con i livelli plasmatici di TNF e correlazione con i livelli plasmatici di TNF e PAFPAF

no. 20no. 20

PFPFRR

LPSLPS0.05 0.05 mg/kgmg/kg

LPSLPS0.05 0.05 mg/kgmg/kg no. 19no. 19

PFPF

Hemodynamic response to coupled Hemodynamic response to coupled plasmafiltration-adsorption in human plasmafiltration-adsorption in human septic shock septic shock

Marco Formica, Carlo Olivieri, Sergio Livigni, Giulio Marco Formica, Carlo Olivieri, Sergio Livigni, Giulio Cesano, Antonella Vallero, Mariella Maio and Ciro TettaCesano, Antonella Vallero, Mariella Maio and Ciro Tetta

Intensive Care Med (2003) 29: 703-708Intensive Care Med (2003) 29: 703-708

ObjectiveObjective:: The objective was to examine the effect of repeated The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs).intensive care units (ICUs).

ConclusionConclusion:: Coupled plasmafiltration-adsorption was a feasible and Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamic, the pulmonary function, and the outcome in in the hemodynamic, the pulmonary function, and the outcome in septic shock patients septic shock patients with or without concomitant ARFwith or without concomitant ARF..

PLASMAFILTRAZIONE E PLASMAFILTRAZIONE E ADSORBIMENTO ASSOCIATE (CPFA)ADSORBIMENTO ASSOCIATE (CPFA)

PLASMAFILTRAZIONE E PLASMAFILTRAZIONE E ADSORBIMENTO ASSOCIATE (CPFA)ADSORBIMENTO ASSOCIATE (CPFA)

• LYNDALYNDA (Bellco, Mirandola, Italia)• PlasmafiltroPlasmafiltro (Polieteresulfone MICROPES®

0.45 m2 cut-off di circa 800 kDa)• Cartuccia di resine idrofobicheCartuccia di resine idrofobiche (140 ml per

70 gr, con superficie adsorbente di circa 700 m2/gr)

• EmofiltroEmofiltro (Polieteresulfone DIAPES®-HF 1.2 m2, CVVH, CVVHD)