The effect of therapeutic plasma exchange on the inflammatory response in septic shock: a secondary analysis of the EXCHANGE-1 trial

BACKGROUND: Sepsis and septic shock, defined by a profound immune dysregulation, are among the leading causes of death in the intensive care unit (ICU). Despite advances in understanding the underlying pathophysiology, evidence for specific immunomodulatory treatment does not exist to date. Therapeutic plasma exchange (TPE) represents an adjunctive treatment approach to rebalance immune homeostasis. In the EXCHANGE-1 trial, we recently demonstrated a rapid hemodynamic improvement, possibly caused by the removal of harmful mediators and the replacement of protective plasma proteins. The aim of this secondary analysis is to further characterize the underlying immunomodulatory effects and to identify biomarkers that may predict treatment response. METHODS: This secondary analysis included patients in early septic shock (< 24 h duration) and a norepinephrine (NE) dose of

• Sauer, A.
• Stahl, K.
• Seeliger, B.
• Wendel-Garcia, P. D.
• Lehmann, F.
• Schmidt, J. J.
• Schmidt, B. M. W.
• Welte, T.
• Peukert, K.
• Wild, L.
• Putensen, C.
• David, S.
• Bode, C.