Background: The extracorporeal removal of mediators is a rescue strategy for septic shock patients, which is still under investigation. Several techniques are available: coupled plasma filtration and adsorption (CPFA) combines plasma processing with renal replacement therapy. Methods: The study aimed to elucidate the role of both timing of initiation and intensity of treatment on the outcome, for which we retrospectively studied 52 patients. We collected the overall pre-CPFA time interval, starting from the first episode of hypotension in the wards and the volume of processed plasma (Vp), which we used as a proxy for intensity of treatment. Results: Timing of initiation did not significantly differ between survivors and non-survivors (25 vs. 27 h), while the Vp did (0.25 vs. 0.17 L/kg/session, p < 0.05). The significance of Vp was confirmed by a multiple logistic regression model. Conclusion: Our study confirms that intensity of CPFA, but not its timing of initiation, correlates with survival of septic shock patients.

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al: Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 45: 486–552.
Rimmelé T, Kellum JA: Clinical review: blood purification for sepsis. Crit Care 2011; 15: 205.
Ronco C, Brendolan A, d’Intini V, Ricci Z, Wratten ML, Bellomo R: Coupled plasma filtration adsorption: rationale, technical development and early clinical experience. Blood Purif 2003; 21: 409–416.
Livigni S, Bertolini G, Rossi C, Ferrari F, Giardino M, Pozzato M, et al: Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open 2014; 4:e003536.
Berlot G, Agbedjro A, Tomasini A, Bianco F, Gerini U, Viviani M, et al: Effects of the volume of processed plasma on the outcome, arterial pressure and blood procalcitonin levels in patients with severe sepsis and septic shock treated with coupled plasma filtration and adsorption. Blood Purif 2014; 37: 146–151.
Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A, et al: A pilot study of coupled plasma filtration with adsorption in septic shock. Crit Care Med 2002; 30: 1250–1255.
Formica M, Olivieri C, Livigni S, Cesano G, Vallero A, Maio M, et al: Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock. Intensive Care Med 2003; 29: 703–708.
Cesano G, Livigni S, Vallero A, Olivieri C, Borca M, Quarello F, et al: [Treatment of septic shock with the use of CPFA (associated plasma filtration and adsorption): impact on hemodynamics monitored with PiCCO]. G Ital Nefrol 2003; 20: 258–263.
Hu D, Sun S, Zhu B, Mei Z, Wang L, Zhu S, et al: Effects of coupled plasma filtration adsorption on septic patients with multiple organ dysfunction syndrome. Ren Fail 2012; 34: 834–839.
Franchi M, Giacalone M, Traupe I, Rago R, Baldi G, Giunta F, et al: Coupled plasma filtration adsorption improves hemodynamics in septic shock. J Crit Care 2016; 33: 100–105.
Hazzard I, Jones S, Quinn T: Coupled plasma haemofiltration filtration in severe sepsis: systematic review and meta-analysis. J R Army Med Corps 2015; 161(suppl 1):i17–i22.
Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva. COMPACT: COMbining Plasmafiltration and Adsorption Clinical Trial [online]. (accessed May 20, 2018).
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