Continuous Hemodiafiltration with a Cytokine-Adsorbing Hemofilter for SepsisHirasawa H.a · Oda S.a · Nakamura M.a · Watanabe E.a · Shiga H.b · Matsuda K.c
aDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, bDepartment of Emergency and Critical Care Medicine, Teikyo University Chiba Medical Center, Chiba, and cDepartment of Emergency and Critical Care Medicine, Yamanashi University School of Medicine, Yamanashi, Japan
Keywords: HypercytokinemiaPathogen-associated molecular patternsAlarminEndotoxinCytokine-adsorbing hemofilterPolymethyl methacrylate hemofilterAN69ST hemofilterContinuous hemodiafiltrationHigh-volume continuous hemofiltrationDirect hemoperfusion with polymyxin-B-immobilized column
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Since the introduction of the new pathophysiological concept of pathogen-associated molecular patterns (PAMPS) and alarmins, endotoxin has been recognized as only one of the PAMPS. It is widely accepted that hypercytokinemia plays a pivotal role in the pathophysiology of sepsis. Many kinds of blood purification modalities have been proposed as a therapeutic tool against sepsis, including high-volume continuous hemofiltration whose efficacy has recently been questioned. We report that continuous hemodiafiltration (CHDF) with a cytokine-adsorbing hemofilter (CAH), such as polymethyl methacrylate hemofilter and AN69ST hemofilter (CAH-CHDF), can remove many kinds of cytokines and has been very effective in the treatment of severe sepsis and septic shock. Based on the understanding of the recent pathophysiology, we suggest that CAH-CHDF is an alternate therapy to direct hemoperfusion with endotoxin-adsorbing column in the treatment of sepsis.
© 2012 S. Karger AG, Basel
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