Plasmosorption

Plasmosorption is carried out by plasma perfusion through a sorbent. The procedure can be carried out in a continuous mode, and then the column with the sorbent is located in the extracorporeal circuit.

With intermittent blood fractionation, the resulting plasma is perfused through a sorbent in the recirculation mode by means of a pump. Purified from plasma slags intravenously reinfused to the patient. Column detoxifier can contain from 100 to 400 ml of sorbent.

Plasmosorption is considered sufficient for perfusion of 1.5-2 OCV through 200 ml of sorbent. Control over the effectiveness of detoxification is carried out by calculating the clearance and elimination of the test substance.

[1], [2], [3], [4]

Mechanism of action

Plasmosorption aims to remove circulating large and medium molecular weight toxic substances. When the plasma is perfused through the sorbent, toxic metabolites are fixed on its surface and in the pores. The low viscosity of the plasma and the lack of uniform elements explain the greater efficiency of removal of exogenous toxic substances during plasmosorption in comparison with HS.

Expected effect of plasmosorption

Excretion of large and medium molecular toxic metabolites leads to an improvement in the general condition of the patient, creates favorable conditions for the functioning of all body systems.

Plasmosorption in combination with plasmapheresis and plasmodialysis contributes to the detoxification of the body over a wide range of toxic substances, which differ significantly in their physico-chemical properties and molecular weight. Complex detoxification of plasma has a beneficial effect on the function of all vital organs and systems of the patient.

[5], [6], [7], [8], [9], [10],

Plasma methods of organism detoxication in acute endotoxicosis

Equipment	For the separation of blood into blood elements and plasma, the following devices are used: a) for centrifugal fractionation; b) for carrying out membrane fractionation, plasma filters and an artificial kidney apparatus are used; for intermittent (discrete) fractionation, a centrifuge. Blood of the patient (300-500 ml) is collected in special vials or plastic bags with anticoagulant -. Hepa sodium Rin, glyugitsirom etc. Then, using a centrifuge (rotor speed about 1800-2500 min1) blood is separated into two parts - cell slurry into a precipitate and the plasma (supernatant Yid bone) Toxic metabolites are concentrated mainly in the plasma much smaller part of them - on the surface of red blood cells from the toxic substances erythrocytes can be washed by dilution into saline or perfusion through the sorbent to apply plasma sorption sorbents
System of highways	In accordance with the methodology of the procedure, a set of trunks designed for this separator
Vascular access	Central Vienna
Preliminary preparation	Prior to the initiation of the removal of the patient's plasma (plasmapheresis), intravenous infusion of protein preparations is recommended, for example, 200 ml of plasma or colloids. In hematocrit, equal to 45% and higher, preliminary hemo dilution is necessary. Optimal hematocrit in the range of 35-40% Depending on the parameters of the blood coagulation system, general or regional heparinization of the patient is carried out in the procedure of the discrete variant, the anticoagulant is contained in special plastic pa ket, which does not require heparinization of the patient
Method of perfusion of blood	When performing the procedure of continuous separation, blood from the patient through the system of lines is fed to a fractionating device (separating device) - a centrifuge or plasma filter - from a perfusion pump, from which it is diverted by two lines, one of which contains plasma and the other - a cellular suspension. The extracorporeal circuit closes the connecting line, one of the veins of the patient are injected blood cells. The isolated plasma can be detoxified with sorbent (plasmosorption) and intravenously returned to flax emission of toxic plasma can be removed during the plasmapheresis with its subsequent replacement protein solutions When conducting intermittent separation patient's blood was collected in special plastic containers containing an anticoagulant and then centrifugally separated into two fractions of blood cells and plasma using a special urging devices plasma removed from the container with its subsequent substitution with an equal volume of isotonic sodium chloride solution diluted shaped elements s blood returned to the patient intravenously The isolated plasma can be substituted with protein preparations detoxified by either plasma sorption and then intravenously administered to a patient
Volume of perfusion of blood, plasma	In the procedure of plasmapheresis, the volume of blood perfusion determines the hematocrit number. To achieve a detoxification effect, an average of 800-2500 ml of plasma is replaced. When plasmodialysis or plasmosorption is performed through a detoxification device, 1.5-2 VCP
Recommended Modes	In the centrifugal separation of blood, the rotor rotation speed is 1800-2300 rpm. When carrying out plasmodialysis or plasmosorption procedures, the plasma flow rate in the extracorporeal circuit depends on the volume of plasma obtained during blood separation
Indications for use	Plasmapheresis toxemia large-molecule (myoglobin) or protein-bound (bilirubin) substances, fibrinolysis bleeding in the background of intoxication In these cases, plasma should be replaced by a freshly frozen donor plasma Plasmosorption intoxication with medium- and large-molecule toxic metabolites It is applied additionally to plasmapheresis for enhancing the detoxification effect. The use of plasmosorption as an independent procedure is impractical Preference should be given to HS - economically cheaper pr cedure, although the magnitude of the clearance and elimination of toxic metabolites in the plasma sorption higher than GS
Contraindications	Hypoproteinemia (total protein less than 40 g / l), acute cardiovascular failure (BP below 80/40 mm Hg), the risk of bleeding associated with heparinization of the patient, intolerance of foreign protein
Complications	In the procedures of plasmapheresis, plasmodialysis, plasmosorption, the following complications are possible: acute cardiovascular insufficiency a) rapid blood exfusion, especially with the "complicated" extracorporeal system (plasma filter, dialyzer / sorbent / trunk), filled with blood and plasma of the patient b) due to hypocalcemia in intravenous the introduction of an excessive amount of sodium citrate as an anticoagulant of anaphylactic shock
Blood perfusion rate	Depends on the possibility of the separating device