Résumé
Objectif
Le choc septique est une cause fréquente de défaillance multiviscérale et de mortalité en réanimation. Sa pathogénie semble liée à une libération excessive de médiateurs pro- et anti-inflammatoires, conduisant à une hyporéactivité immunitaire. Plusieurs stratégies thérapeutiques, ayant pour but de réduire les concentrations sanguines et tissulaires de ces médiateurs, ont été développées, dont une technique d’épuration extrarénale appelée «filtration et adsorption plasmatiques couplées» (FAPC), ou «coupled plasma filtration adsorption».
Source
Les articles en langue anglaise ou française publiés entre 1984 et 2008 ont été recherchés dans la base de données Medline. Les mots clés et les termes MeSH utilisés étaient: «coupled plasmafiltration», «plasma filtration», «adsorption», «blood purification», «cytokines», «hemofiltration» et «sepsis». Les études pertinentes ont été extraites et examinées à la recherche d’autres sources. Neuf articles ont ainsi été retenus.
Constatations principales
La FAPC est une méthode d’épuration continue basée sur l’adsorption non spécifique des cytokines plasmatiques par une résine synthétique, couplée à une hémofiltration. Les études expérimentales ainsi que les premiers essais cliniques ont montré des résultats intéressants sur les paramètres hémodynamiques et respiratoires, mais ces travaux n’ont pas pu mettre en évidence de bénéfice sur le pronostic vital.
Conclusion
Une nouvelle évaluation semble done nécessaire afin de préciser la place de cette technique de purification sanguine dans I’arsenal thérapeutique du choc septique.
Abstract
Purpose
Septic shock is the leading cause of multiple organ failure and mortality in intensive care units. This condition seems to be related to an overproduction of both pro- and anti-inflammatory mediators, leading to an immunological dysfunction. Therapeutic strategies aimed at reducing blood and tissue concentrations of these mediators have been developed. One of these techniques, based on extra-renal filtration, is called “coupled plasma filtration and adsorption”.
Source
English and French language articles published between 1984 and 2008 were identified through a computerized Medline search. Keywords and MeSH terms used were: «coupled plasmafiltration», «coupled plasma filtration», «adsorption», «blood purification», «cytokines», «hemofiltration», «sepsis». Relevant publications were retrieved and scanned for additional sources. Nine publications were found.
Principal findings
Coupled plasma filtration adsorption is an extra-corporeal treatment, based on non-specific cytokine adsorption on a specially designed resin cartridge, coupled with hemofiltration. Experimental studies and the first clinical trials have shown interesting results regarding hemodynamics and respiratory parameters. However, these trials failed to demonstrate any improvement in outcome.
Conclusion
Additional evidence is needed to clarify the role of this blood purification technique for the treatment of septic shock.
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Page, M., Rimmele, T. Filtration et adsorption plasmatiques couplées : principe et perspectives dans le traitement du choc septique. Can J Anesth 55, 847–852 (2008). https://doi.org/10.1007/BF03034056
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DOI: https://doi.org/10.1007/BF03034056