1. Risposta infiammatoria - Dove siamo? -
Infection
Sepsis
Severe Sepsis
MODS
Death
“mixed”
“pro”
SIRS =
Systemic inflammatory response syndrome
CARS =
Compensatory anti-inflammatory response syndrome
Hyper-inflammation
Normal
Immunoparalysis
“anti”

2. high-molecular-weight kininogen
Immunosuppression is a primary rather than a compensatory response to sepsis
Pathogens promote the early activation of the contact system
factor XII
prekallicrein
high-molecular-weight kininogen
and the complement cascade, and induce the rapid release of inflammatory mediators from monocytes and endothelial cells, which correspond to the clinical designation of SIRS.
Simultaneously, endogenous antinflammatory pathways are activated, which dampen the inflammatory response:
the compensatory anti-inflammatory response syndrome (CARS).
Int J Artif Organ 2002; 25:

3. Volume 355:
    
September 7, 2006
Number 10

4. Volume 355:
    
September 7, 2006
Number 10

5. Volume 355:
    
September 7, 2006
Number 10

6. Peak concentration hypotesis RONCO et all
RISPOSTA PRO E ANTI-INFIAMMATORIA
Peak concentration hypotesis RONCO et all
Concentrazione plasmatica
LPS
TNF
IL-1
IL-6
IL-8
IL-10
C.P.F.A.
Stimolo endotossinico
tempo

7. Coupled Plasma Filtration Adsorption Modello dello shock settico
1.0
R+ 16/20 (80%) PF R
0.8
LPS
0.05 mg/kg
no. 20
0.6
Sopravvivenza Cumulativa
0.4 PF
L+ 5/ (25%)
0.2
LPS
0.05 mg/kg
no. 19 2 4 6 8
giorni
Miglioramento della sopravvivenza senza correlazione con i livelli plasmatici di TNF e PAF
Tetta C et al. Crit Care Med 2000; 28:

8. Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock
Marco Formica, Carlo Olivieri, Sergio Livigni, Giulio Cesano, Antonella Vallero, Mariella Maio and Ciro Tetta
Intensive Care Med (2003) 29:
Objective: The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs).
Conclusion: Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamic, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.

9. PLASMAFILTRAZIONE E ADSORBIMENTO ASSOCIATE (CPFA)
LYNDA (Bellco, Mirandola, Italia)
Plasmafiltro (Polieteresulfone MICROPES® 0.45 m2 cut-off di circa 800 kDa)
Cartuccia di resine idrofobiche (140 ml per 70 gr, con superficie adsorbente di circa 700 m2/gr)
Emofiltro (Polieteresulfone DIAPES®-HF 1.2 m2, CVVH, CVVHD)