IMMUNOMODULATION, IMMUNOSTIMULATION AND EXTRACORPOREAL BLOOD PURIFICATION IN SEPSIS: POTENTIALLY BENEFICIAL TECHNIQUES IN CARDIAC SURGERY
https://doi.org/10.21292/2078-5658-2019-16-2-96-106
Abstract
Sepsis is a potentially life-threatening state caused by an infection and an inadequate, dysregulated host immune response. Focusing on cardiac surgery, the prevalence of sepsis is low, after procedures situated between 0.39% and 2.5%. Nevertheless, the current life-expectancy of septic patients are poor, mortality varying from 65% to 79%.
Pathophysiology and immunopathology of sepsis is still unclear. Actually we consider sepsis as a dynamic process with two different sides. Both immune hyperactivity and immune suppression are presented during the progression. Although immunomodulation is not a fresh idea in the treatment of sepsis. Currently the diagnosis of sepsis is based on clinical signs. The biomarkers and molecular diagnostic tools are insufficient.
The actual concept of immunopathophysiology in sepsis is based on the idea of a dynamic parallel immune response, both pro- and antiinflammatory processes are presented from the beginning. Equilibrium may be the key in the immune response of sepsis. Immune system tries to maintain the homeostatic environment during sepsis via pro- and antiinflammatory processes. In case of an unbalanced, dysregulated and radical (in both directions) response mortality become frightfully high. Infectional source control, adequate antibiotic therapy and organ support are the three corner stones in the treatment of sepsis since the definition of sepsis born.
In our review we would like to add a detailed overview on two promising modalities of immunomodulation: (1) extracorporeal blood purification; (2) immunostimulation.
The purpose of present article is to give an up-to-date, comprehensive review on the utilization of extracorporeal blood purification techniques and immunostimulation in septic patient after cardiac surgery.
About the Authors
P. Gianluca
U.O.C. Cardiac Anaesthesia and Cardiac-Intensive Care, San Carlo Hospital
Italy
Potenza
Italy
Potenza
Á Nagy
U.O.C. Cardiac Anaesthesia and Cardiac-Intensive Care, San Carlo Hospital;
Károly Rácz School of PhD Studies, Semmelweis University
Italy
Italy
Potenza;
Budapest, Hungary
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Review
For citations:
Gianluca P., Nagy Á. IMMUNOMODULATION, IMMUNOSTIMULATION AND EXTRACORPOREAL BLOOD PURIFICATION IN SEPSIS: POTENTIALLY BENEFICIAL TECHNIQUES IN CARDIAC SURGERY. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2019;16(2):96-106. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-2-96-106
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