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Risposta infiammatoria - Dove siamo? - InfectionSepsis Severe Sepsis MODS Death SIRS = Systemic inflammatory response syndrome CARS = Compensatory anti-inflammatory.

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Presentation on theme: "Risposta infiammatoria - Dove siamo? - InfectionSepsis Severe Sepsis MODS Death SIRS = Systemic inflammatory response syndrome CARS = Compensatory anti-inflammatory."— Presentation transcript:

1 Risposta infiammatoria - Dove siamo? - InfectionSepsis Severe Sepsis MODS Death SIRS = Systemic inflammatory response syndrome CARS = Compensatory anti-inflammatory response syndrome Hyper-inflammation Normal Immunoparalysis propro mixedmixed antianti

2 Int J Artif Organ 2002; 25:

3 Volume 355: September 7, 2006 September 7, 2006 Number 10

4 Volume 355: September 7, 2006 September 7, 2006 Number 10

5 Volume 355: September 7, 2006 September 7, 2006 Number 10

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

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

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) LYNDALYNDA (Bellco, Mirandola, Italia) PlasmafiltroPlasmafiltro (Polieteresulfone MICROPES ® 0.45 m 2 cut-off di circa 800 kDa) Cartuccia di resine idrofobicheCartuccia di resine idrofobiche (140 ml per 70 gr, con superficie adsorbente di circa 700 m 2 /gr) EmofiltroEmofiltro (Polieteresulfone DIAPES ® -HF 1.2 m 2, CVVH, CVVHD)


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