Zusammenfassung
Sepsis ist eine systemische Inflammationsreaktion des Organismus auf eine – häufig lokale – Infektion, für die es gegenwärtig keine zugelassene spezifische pharmakologische Therapie gibt. Daher wird neben der Sanierung des Infektfokus und der antiinfektiven Therapie mit verschiedenen extrakorporalen Verfahren versucht, die erhöhten zirkulierenden Spiegel schädigender Mediatoren zu reduzieren. Hierfür werden zunehmend Adsorber eingesetzt, die aber nicht den gleichzeitigen Ersatz verbrauchter protektiver Faktoren ermöglichen. Der Plasmaaustausch stellt hingegen ein Verfahren dar, das sowohl die Entfernung von proinflammatorischen Mediatoren als auch die Substitution protektiver Faktoren erlaubt. Nachfolgend wird der Fall eines septischen Schocks geschildert, bei der die Plasmapherese zu einer prompten klinischen Besserung führte. Ferner wird die gegenwärtige Studienlage hierzu zusammengefasst.
Abstract
Sepsis is defined as a systemic inflammatory response of the body to an infection. Besides anti-infective drugs and removal of the site of infection, no specific therapeutics that target the overwhelming host response are available. Clinical researchers are currently evaluating the extracorporeal elimination of circulating cytokines. Modern adsorbing techniques have increasingly been used for this purpose allowing an unselective but highly effective removal of the vast majority of circulating cytokines but also fail to replace used protective factors in patients’ plasma. Therapeutic plasma exchange (TPE) however might represent a novel method to remove pathologically elevated cytokines and simultaneously to replace protective plasmatic factors. Here we report the case of a septic shock patient treated with TPE and review the available literature with respect to TPE as an adjunctive therapy in sepsis.
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S. David, M.M. Hoeper und J.T. Kielstein geben an, dass kein Interessenkonflikt besteht.
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David, S., Hoeper, M. & Kielstein, J. Plasmaaustausch im therapierefraktären septischen Schock. Med Klin Intensivmed Notfmed 112, 42–46 (2017). https://doi.org/10.1007/s00063-015-0117-9
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DOI: https://doi.org/10.1007/s00063-015-0117-9