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Risposta infiammatoria - Dove siamo? -

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Presentation on theme: "Risposta infiammatoria - Dove siamo? -"— Presentation transcript:

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.

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)

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