TPE TRONG SEPSIS SEPTIC SHOCK

TPE TRONG SEPSIS & SEPTIC SHOCK THS.BS HỒ HOÀNG KIM KHOA HSTC-CĐ BV NGUYỄN TRI PHƯƠNG... The Third International Consensus Definitions for Sepsis and Septic Shock Sepsis-3 “Sepsis is def

TPE TRONG SEPSIS & SEPTIC

SHOCK

THS.BS HỒ HOÀNG KIM KHOA HSTC-CĐ

BV NGUYỄN TRI PHƯƠNG

The Third International Consensus Definitions for Sepsis and Septic

Shock (Sepsis-3)

“Sepsis is defined as life-threatening organ dysfunction caused by a

JAMA 2016;315(8):801-810 doi:10.1001/jama.2016.0287

Patrick M Honore, Cytokine removal in human septic shock: Where are we and where are we going? Ann Intensive Care 2019; 9: 56.

Crit Care Med 2003 Jun;31(6):1730-6.

– feasibility and safety of the procedure

– hemodynamic improvement indicated by a NE reduction often achieved within minutes after TPE start

– improved preload and fluid balance possibly due to a protective effect on vascular

permeability

– decline in plasma concentrations of proinflammatory mediators

– reversibility of the septic endothelial phenotype ex vivo from 60% of patients plasma after TP

Therapeutic Plasma Exchange in Adults Patients With Severe Sepsis

• Estimated Study Start Date :February 1, 2020

• Estimated Primary Completion Date : February 28, 2021

• Estimated Study Completion Date : February 28, 2021

Primary Outcome Measures :

• Vasopressor decrease [ Time Frame: 24 hours within TPE use ] >50% vasopressor decrease within 24hours of (each)TPE use

• Improvement in Sepsis-related Organ Failure Assessments(SOFA) 24hour and 7 days after TPE use [ Time Frame: 24 hours, and 7 days within TPE use ]

• Improvement in Sepsis-related Organ Failure Assessments(SOFA) Score of at least 1 point in each of the 5 domains of SOFA score within 24 hour and 7 days after TPE use

Secondary Outcome Measures :

• Ventilator days [ Time Frame: 28 days within admission ]

• ICU days [ Time Frame: 28 days within admission ]

• Mortality [ Time Frame: 28 days ]

• Renal replacement therapy (RRT) [ Time Frame: 7 days and ICU discharge ]

Inclusion Criteria:

• Adult patients with a documented or strong clinical suspicion of infection

• Meet the definition of septic shock as per the Third International Consensus Definitions for Sepsis and Septic Shock

• > 30 mls/kg fluid resuscitation

• noradrenaline >0.1 ug/kg/min to maintain MAP> 65 mmHg for at least 4 consecutive hours and present at initiation of TPE

• lactate >2 mmol/l

Therapeutic Plasma Exchange in the Treatment of Sepsis Associated Multi-Organ Failure [SAMOF-TPE] (SAMOF-TPE)

• Estimated Study Start Date : June 2019

• Estimated Primary Completion Date : December 2022

• Estimated Study Completion Date : June 2023

Primary Outcome Measures :

• 28-Day Mortality [ Time Frame: 28 days ]

Inclusion Criteria:

• Adult patients are eligible for inclusion if they have sepsis with refractory shock and evidence of organ failure

Plasmaexchange in Early Septic Shock (EXCHANGE)

• Actual Study Start Date : January 2016

• Estimated Primary Completion Date : January 2021

• Estimated Study Completion Date : July 2021

• 352 BN

Primary Outcome Measures :

• Mortality [ Time Frame: 28 days ]: Overall mortality

Inclusion Criteria:

• Onset of septic shock within less than 12 hrs

• Noradrenaline dose of ≥ 0.4 ug/kg/min bodyweight (target MAD ≥ 65 mmHg) ≥ 30 min

Thông điệp từ các chứng cứ:

• TPE trong SEPTIC SHOCK là 1 biện pháp cứu vãn cần được xem xét

• Lấy các “mediators” trong tuần hoàn, “bù đắp” => điều hòa đáp ứng của vật chủ

• SỚM (< 12H)

• Noradrenaline 0,4-0,6 mcg/kg/phút

• Cần theo dõi các NC đang tiến hành để có them bằng chứng

• ASFA 2019: Grade 2B