Plasmapherese bei Sepsis

Despite the comprehensible theoretical rationale and biological plausibility, there is so far a lack of clear evidence for or against extracorporeal blood purification strategies; however, in the last 3 years several high-quality studies that make reference to a comparable intervention, have indicated that the unselective removal of circulating mediators in critically ill sepsis patients could be unexpectedly harmful. Although therapeutic plasma exchange (TPE) is also an extracorporeal treatment, it follows a fundamentally different biological approach. Here, the entire plasma volume is removed and simultaneously replaced with healthy donor plasma. The hypothesis behind a beneficial effect of TPE on the pathophysiology of sepsis is based on the idea of combining the removal of excessive damaging mediators with the substitution of protective factors that are consumed in sepsis. Several recent meta-analyses, including the results of the EXCHANGE study program and retrospective propensity score analyses, have consistently found significantly improved survival in patients with septic shock treated with additional TPE; however, the proof that TPE can actually improve the survival of patients with septic shock is still pending.