Short-term cardiovascular effects of plasmapheresis in norepinephrine-refractory septic shock

Objective: To examine the short-term cardiovascular effects of plasmapheresis in seven patients (six surgical, one medical) with norepi- nephrine-refractory septic shock. Design and setting:Retrospective observational study in a secondary community hospital. Interventions: Plasmapheresis was performed as follows: blood flow, 120 ml/min; ex- change volume, 10 fresh frozen plas- ma (ca. 2200 ml) at rate of 13 ml/min; anticoagulation, unfrac- tionated heparin 200-300/IU/h. Five patients received one separation and two patients three separations. All patients received norepinephrine in- travenously (0.6±0.7 µg/kg per minute) to achieve a mean arterial pressure of 77±12 mmHg. All pa- tients received ventilatory support; two had acute oligoanuric renal fail- ure treated by continuous hemodia- filtration. Measurements and results:We re- corded heart rate, mean arterial pres- sure, central venous pressure, cate- cholamine dose, gas exchange, acid- base status, diuresis, C-reactive pro- tein, white blood cell count, and Simplified Acute Physiological Score II. Except for transitory de- creases in central venous pressure no changes were found in any variable. Six of seven patients died 5±3 days after the last plasmapheresis. Conclusions: In patients with norepi- nephrine-refractory septic shock no directional changes in measured vari- ables were found in the first 24 h after a plasmapheresis. Thus, regarding the cost (ca. 1000 euros per separation) and possible risks the procedure needs rigorous evaluation even as "rescue therapy" in patients with septic shock.