Total body washout for the treatment of endotoxin shock. An experimental study

Total hypothermic blood exchange in acute endotoxin shock

It has been reported that total hypothermic blood exchange holds promise for the treatment of septic shock in animals. Since this procedure does not carry any mortality in out laboratory, we studied its effect in an acute septic shock model. After the intravenous injection of endotoxin (10 mg/kg) and blood transfusions into 33 dogs, severe haemoconcentration, tachypnoea, tachycardia, low cardiac output, metabolic acidosis and hyperpyrexia led uniformly to death within 5 h. All of these symptoms were prevented in five dogs by total hypothermic blood exchange, instituted 5 min after the endotoxin injection. Nevertheless, all of these treated animals died a delayed death. Since the endotoxin particles are rapidly phagocytosed by the reticulo-endothelial system, even very early total blood exchange cannot dislodge them from their intracellular site.

[Hypothermic circulatory arrest after total blood exchange in dogs (author's transl)]

Total body washout (hct less than 1%) in hypothermia was performed in 31 dogs using either a crystalloidal or a colloidal perfusate. Blood exchange and cooling was achieved by means of partial bypass and heat exchanger. Short lasting blood exchange for crystalloids without cardiac arrest resulted in 66% survival of the animals. When in addition circulatory arrest was established for 30 min at 14 degrees C oesophageal temperature blood exchange for crystalloids was not tolerated. All four animals of this group died within 19 hours presenting massive interstitial edema. Replacement of the crystalloidal perfusate by a colloidal solution (2.5 g% Dextran 60 at Ringer's Lactate) and establishing circulatory for 30 or 60 min resulted in survival rates of 71% and 50% respectively. The use of the colloidal perfusate effectively prevented edema formation. Death could not be correlated with the parameters controlled.

Treatment of septicaemia in the newborn infant: choice of initial antimicrobial drugs and the role of exchange transfusion

The therapeutic success of antibiotics used at the beginning of treatment and the effect of exchange transfusion in cases of septicaemia were tested in 22 newborn infants. The clinical course of these patients was compared with the outcome of 11 newborn infants who received antibiotic treatment without exchange transfusion. The following results were obtained: 1) All 6 patients initially receiving antibiotics, which were ineffective in vitro, died. In this group of patients the incidence of septic organ involvements (meningitis, ventriculitis, peritonitis) was significantly increased. 2) Following exchange transfusion, an impressive clinical improvement was consistently observed. 3) In patients who had initially received effective antibiotics and exchange transfusion, the lethality was significantly lower than in patients without exchange transfusion. 4) Our bacteriological findings show that continuous monitoring of cultures from blood, CSF and stool is necessary to choose the most effective antibiotic in the prevailing nosocomical circumstances.

Total blood washout and exchange. A valuable tool in acute hepatic coma and Reye's syndrome

Total body washout (TBW) was accomplished thirteen times in twelve patients, with response in five and survival in three. TBW can be done without apparent harm to patients and is less laborious and more rapidly effective than repeated exchange transfusion. Early application of TBW in stage III to stage IV hepatic coma may increase survival and possibly prevent progression of metabolic derangements. Patients with stage III to IV Reye's syndrome probably should have TBW promptly, without time-consuming attempts at exchange transfusion. Based on our experience, further application of TBW is warranted in coma due to acute hepatic failure and stage III to IV Reye's syndrome.