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Der Klinikarzt 2020; 49(05): 216-222
DOI: 10.1055/a-1153-7747
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Extrakorporale Therapiestrategien in der Sepsis

Eine Übersicht verschiedener Verfahren und deren Evidenz
Sascha David
1   Internistische Intensivmedizin/Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover
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Publication History

Publication Date:
12 May 2020 (online)

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ZUSAMMENFASSUNG

Sepsis ist eine lebensbedrohliche Organdysfunktion, hervorgerufen durch eine pathologische Wirtsantwort auf eine Infektion. Eine spezifische Therapie hiergegen wäre wünschenswert, konnte aber bisher nicht etabliert werden. Die Blockade einzelner Komponenten des Immunsystems (z. B. TNF, TLR4) lieferte zwar überzeugende Resultate in der präklinischen Forschung, scheiterte jedoch in kontrollierten klinischen Studien. Daher ist eine nicht selektive Elimination verschiedener zirkulierender Faktoren in den letzten Jahren in den Fokus wissenschaftlichen Interesses gerückt. In dieser Übersicht werden unterschiedliche extrakorporale Verfahren und deren Evidenz zur Therapie der Sepsis vorgestellt. Der therapeutische Plasmaaustausch nimmt in gewisser Weise eine Sonderstellung ein, da neben der Elimination schädigender Substanzen gleichzeitig durch die Sepsis verbrauchte protektive Faktoren ersetzt werden können. Zusammenfassend handelt es sich um innovative Apparaturen auf dem Boden eines überzeugenden theoretischen Konzeptes mit teilweise guten Effekten in kleinen Pilotstudien. Randomisiert kontrollierte Studien sind jedoch rar, sodass belastbare Daten bis dato leider fehlen.

 

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