Endotoxemia and Endotoxin Shock

Description

The presence of endotoxin in the bloodstream is the consequence of an immunological response triggered by bacterial invasion of the host. This condition leads to altered cardiovascular function, lung dysfunction and acute kidney injury. Removing as much as possible of the circulating endotoxin is therefore imperative to mitigate its biological and clinical effects at the cellular, tissue and organ levels. The publication at hand summarizes the basic mechanisms, rationale and clinical results of a new therapeutic approach that promises to attain this goal: It consists of a specific hemoperfusion process that utilizes cartridges with immobilized polymixin B in an extracorporeal circuit.Containing contributions by renowned researchers, this book represents as a milestone in the field of extracorporeal therapies in sepsis. It will be a valuable reference work for both basic scientists and clinical professionals who want to keep abreast of current developments.

Informations

• Publié par: S. Karger AG
• Date de parution: 02 juin 2010
• Nombre de lectures: 0
• EAN13: 9783805594851
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Endotoxemia and Endotoxin Shock: Disease, Diagnosis and Therapy
Contributions to Nephrology
Vol.167
Series Editor
Claudio Ronco     Vicenza
 
Endotoxemia and Endotoxin Shock
Disease, Diagnosis and Therapy
Volume Editors
Claudio Ronco     Vicenza
Pasquale Piccinni     Vicenza
Mitchell H. Rosner     Charlottesville, Va.
22 figures, 4 in color, and 10 tables, 2010
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Claudio Ronco Department of Nephrology Dialysis &Transplantation International Renal Research Institute San Bortolo Hospital IT-36100 Vicenza (Italy)
Pasquale Piccinni Department of Nephrology Dialysis &Transplantation International Renal Research Institute St. Bortolo Hospital IT-36100 Vicenza (Italy)
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Mitchell H. Rosner Division of Nephrology University of Virginia Health System Charlottesville, VA 22908
Library of Congress Cataloging-in-Publication Data
Endotoxemia and endotoxin shock: disease, diagnosis, and therapy / volume editors, Claudio Ronco, Pasquale Piccinni, Mitchell H. Rosner.
p.; cm. -- (Contributionsto nephrology, ISSN 0302-5144;v. 167)
Includes bibliographical references and indexes.
ISBN 978-3-8055-9484-4 (hard cover: alk. paper) - ISBN 978-3-8055-9485-1 (e-ISBN)
1. Endotoxemia. 2. Septic shock. I. Ronco, C. (Claudio), 1951- II. Piccinni, Pasquale. III. Rosner, Mitchell H. IV. Series: Contributions to nephrology, v. 167. 0302-5144 ;
[DNLM:1. Endotoxemia-therapy. 2. Endotoxemia-diagnosis. 3. Hemoperfusion-methods. 4. Polymyxin B-therapeutic use. 5. Shock, Septic-diagnosis. 6. Shock, Septic-therapy. W1 C0778UN V.167 2010 / WC 240 E557 2010]
RC182.S4E527 2010
616.9'4407-dc22
2010017258
Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and Index Medicus.
Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2010 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel
ISSN 0302-5144
ISBN 978-3-8055-9484-4
e-ISBN 978-3-8055-9485-1
 
Contents
Preface
Ronco, C.; Piccinni, P. (Vicenza); Rosner, M.H. (Charlottesville, Va.)
Endotoxemia: Pathophysiological Background
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Endotoxin in the Pathogenesis of Sepsis
Marshall, J.C. (Toronto, Ont.)
Endotoxins and Other Sepsis Triggers
Opal, S.M. (Pawtucket, R.I.)
Extracorporeal Endotoxin Removal: Theory and Technology
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Rationale of Extracorporeal Removal of Endotoxin in Sepsis:Theory, Timing and Technique
Ronco, C.; Piccinni, P. (Vicenza); Kellum, J. (Pittsburgh, Pa.)
Extracorporeal Removal of Endotoxin: The Polymyxin B-Immobilized Fiber Cartridge
Tani, T. (Otsu City); Shoji, H. (Tokyo); Guadagni, G. (Milan); Perego, A. (Monselice)
Mechanisms of Polymyxin B Endotoxin Removal from Extracorporeal Blood Flow: Molecular Interactions
Vesentini, S.; Soncini, M.; Fiore, G.B.; Redaelli, A. (Milan)
Mechanisms of Polymyxin B Endotoxin Removal from Extracorporeal Blood Flow: Hydrodynamics of Sorption
Fiore, G.B.; Soncini, M.; Vesentini, S.; Redaelli, A. (Milan)
Endotoxin Removal in Septic Shock in Clinical Settings
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Endotoxin Removal by Polymyxin B Immobilized Cartridge Inactivates Circulating Proapoptotic Factors
Martin, E.L.; Ranieri, V.M. (Turin)
Polymyxin-B Hemoperfusion and Endotoxin Removal: Lessons from a Review of the Literature
Cruz, D.N.; de Cal, M.; Piccinni, P.; Ronco, C. (Vicenza)
PMX Endotoxin Removal in the Clinical Practice: Results from the EUPHAS Trial
Antonelli, M. (Rome); Fumagalli, R. (Monza); Cruz, D.N. (Vicenza); Brienza, N. (Bari); Giunta, F. (Pisa) on behalf of the EUPHAS Study Group
Early Management of Endotoxemia Using the Endotoxin Activity Assay and Polymyxin B-Based Hemoperfusion
Novelli, G.; Ferretti, G.; Ruberto, F.; Morabito, V.; Pugliese, F. (Rome)
Endotoxin Activity Level and Septic Shock: A Possible Role for Specific Anti-Endotoxin Therapy?
Monti, G.; Bottiroli, M.; Pizzilli, G.; Minnini, M.;Terzi, V.; Vecchi, I.; Gesu, G.; Brioschi, P.; Vesconi, S.; Casella, G. (Milan)
Endotoxin Removal: Building the Evidence
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Endotoxin Removal: How Far from the Evidence? From EUPHAS to EUPHRATES
Rachoin, J.-S. (Camden, N.J.); Foster, D. (Toronto, Ont.); Dellinger, R.P. (Camden, N.J.)
Endotoxin Removal: How Far from the Evidence? The EUPHAS 2 Project
Martin, E.L. (Turin); Cruz, D.N. (Vicenza); Monti, G.; Casella, G.; Vesconi, S. (Milan); Ranieri, V.M. (Turin); Ronco, C. (Vicenza); Antonelli, M. (Rome)
Author Index
Subject Index
Retraction
"Acute Heart Failure Treatment: Traditional and New Drugs" by Gheorghiade M, Palazzuoli A, Ronco C. Contrib Nephrol, 2010;165;112-128.
This chapter of a previous volume of Contributions to Nephrology has been retracted at the authors' request. A miscommunication between the corresponding author and the co-authors resulted in the publishing of an unfinished article.
 
Preface
Several signs and symptoms in sepsis are due to the presence of endotoxin in the circulation. Both in animal and human models there is an evident immunological response to the bacterial invasion of the host and the consequent release of endotoxin into the bloodstream. The presence of endotoxin in the circulation leads to altered cardiovascular function, lung dysfunction and acute kidney injury, often characterizing a clinical picture of sepsis and septic shock. This humoral nature of the syndrome makes it logical to try to remove the circulating endotoxin as much as possible in order to mitigate its biological and clinical effects at the cellular, tissue and organ levels. This can be achieved today with a very specific hemoperfusion process utilizing cartridges with immobilized polymyxin B in an extracorporeal circuit. This approach seems to provide for a significant removal of endotoxin with a significant reduction of its circulating levels.
The basic mechanisms, rationale and the clinical results of this new therapeutic approach are summarized in the present volume. The contributors of this book represent a group of outstanding investigators whose studies have helped expand the scientific knowledge about this field. The clinical effects reported in several chapters demonstrate a mitigation of the septic cascade in the early phases, with amelioration of the prognosis and outcome in septic patients treated with this specific form of hemoperfusion. Recent clinical trials seem to confirm the expectations showing a reduction of mortality in patients with early signs of abdominal sepsis due to recent surgery. This opens new avenues for specific interventions in sepsis and, once more, represents important material for a book in the Contributions to Nephrology series.
We would like to thank the authors and all the contributors for the enormous effort and the quality of their scientific chapters. We also would like to thank all who made this publication possible and especially Karger for the outstanding editorial assistance.
We feel this book will be a milestone in the field of extracorporeal therapies in sepsis and will be a companion for both basic scientists and clinical professionals for their continuous educational improvement.
Claudio Ronco , Vicenza Pasquale Piccinni , Vicenza Mitchell H. Rosner , Charlottesville, Va.
Endotoxemia: Pathophysiological Background
Ronco C, Piccinni P, Rosner MH (eds): Endotoxemia and Endotoxin Shock: Disease, Diagnosis and Therapy. Contrib Nephrol. Basel, Karger, 2010, vol 167, pp 1–13
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Endotoxin in the Pathogenesis of Sepsis
John C. Marshall
Department of Surgery, University of Toronto, and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont., Canada
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Abstract
The word ‘sepsis’ is a descriptive term that denotes the clinical syndrome resulting from the