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Background: This research primarily concentrated on investigating the impact of plasma exchange, especially the modified double filtration plasmapheresis (M-DFPP), in cases of septic shock (SS). Different from traditional plasma exchange which simply removes some macromolecular pathogenic solutes and protein-binding solutes, M-DFPP, based on DFPP, switches the return and discard ports to remove inflammatory mediators more accurately with less plasma used.
Methods: A 67-year-old male patient suffered a right femoral neck fracture in a road accident and underwent right hemiarthroplasty. Twelve days post-surgery, he developed persistent lower abdominal pain and fever. Emergency surgical exploration revealed a retroperitoneal abscess caused by sigmoid colon perforation. Subsequently, the patient was admitted to the ICU for SS treatment. The treatment plan included fluid resuscitation, vasoactive medications, antibiotics, ventilator support, and M-DFPP. Each M-DFPP session exchanged 400 mL of plasma, which accounted for approximately 15% of the patient's total plasma volume. The patient underwent two M-DFPP sessions on the first and second days of admission, with a cumulative treatment time of 4 hours. The long treatment time was due to the need to ensure the stability of the patient's condition during the procedure. Slow-flow operation was adopted to minimize the risk of adverse reactions, such as hypotensive episodes or electrolyte imbalances.
Results: After two rounds of plasma exchange, there was a significant decline in plasma inflammatory factors related to SS, such as a decrease in TNF-α from 76.5 to 25.4 pg/mL, IL-6 from 1,000 to 178 pg/mL, and IL-8 from 7,500 to 512 pg/mL. The patient's hemodynamic condition improved remarkably, with heart rate decreasing from 128 to 95 beats per minute, blood pressure rising from 80/40 to 127/64 mmHg, and urine output increasing from 20 to 125 mL/hour. The dosage of vasoactive medications was gradually reduced until they were no longer required. However, due to ineffective management of the retroperitoneal infection, the patient's sepsis deteriorated on the 38th day of ICU admission, and the patient passed away on the 41st day.
Conclusions: Compared with traditional continuous renal replacement therapies, M-DFPP is more efficient in eliminating inflammatory substances, simplifying the management of SS. It is a safe, user-friendly, and easily implementable method. Early application of M-DFPP can potentially reduce the damage of the body's inflammatory response to organs and lower the risk of organ failure. Future research is expected to further explore its effective-ness and optimal application strategies.
DOI: 10.7754/Clin.Lab.2025.250615
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