| Theme |
Multiple Organ Failure and Blood Purification Therapy |
| Title |
Blood purification in patients with multiple organ failure due to sepsis |
| Author |
Hitoshi Imaizumi |
Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine |
| Author |
Ryoichi Honda |
Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine |
| Author |
Masamitsu Kaneko |
Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine |
| [ Summary ] |
Sepsis is the most common cause of multiple organ failure (MOF). Sepsis is frequently complicated with MOF in patients with an immunosuppressive condition, causing severe deterioration in their condition. As the pathogenesis of sepsis/MOF derives from overproduction of various mediators and disorientation of tissue oxygen metabolism, the infection itself and the mediators must be controlled. Treatments for sepsis are as follows; drainage at the focus of infection; antibiotics sensitive to the bacteria; antifungal drugs sensitive to the fungus; methylprednisolone and protease inhibitors to reduce production and/or release of inflammatory cytokines, and enteral lavage to prevent silent aspiration pneumonia and bacterial translocation. Additionally there are methods of blood purification, such as endotoxin removal therapy and continuous hemodiafiltration (CHDF). Direct hemoperfusion with polymyxin-B immobilized fibers is indicated to remove endotoxins in patients with endotoxemia. CHDF is indicated to remove various mediators, which produce organ injury, and to maintain homeostasis of fluids, acid-base balance and electrolytes. However, catheter-related sepsis and therapeutic drugs, removed partially by blood purification, are possibilities which must be considerd. |