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 defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.” 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 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 days after TPE use [ Time Frame: 24 hours, and days within TPE use ] • Improvement in Sepsis-related Organ Failure Assessments(SOFA) Score of at least point in each of the domains of SOFA score within 24 hour and 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: 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 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 Exclusion Criteria: • Age 80 years • Pregnancy • Known history of transfusion reactions Thơng điệp từ chứng cứ: • TPE SEPTIC SHOCK biện pháp cứu vãn cần xem xét • Lấy “mediators” tuần hồn, “bù đắp” => điều hòa đáp ứng vật chủ • SỚM (< 12H) • Noradrenaline 0,4-0,6 mcg/kg/phút • Cần theo dõi NC tiến hành để có them chứng • ASFA 2019: Grade 2B ... 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...The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis- 3) ? ?Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated... 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 days after TPE use [ Time Frame: