***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To test the hypothesis that nonselective plasma adsorption by a hydrophobic resin ( coupled plasmafiltration and adsorption ) could improve hemodynamics and restore leukocyte responsiveness in patients with septic shock . Design Prospect i ve , pilot , crossover clinical trial . Setting General intensive care unit in a teaching hospital . SubjectsTen patients with hyperdynamic septic shock . Interventions Patients were r and omly allocated to 10 hrs of either coupled plasma filtration adsorption plus hemodialysis ( treatment A ) or continuous venovenous hemodiafiltration ( treatment B ) in r and om order . We measured the change in mean arterial pressure , norepinephrine requirements , and leukocyte tumor necrosis factor-&agr ; ( TNF-&agr ; ) production ( both spontaneous and lipopolysaccharide-stimulated ) after 10 hrs of each treatment . We also tested TNF-&agr ; production from normal human adherent monocytes incubated with patients ’ plasma obtained before and after the resin , both with or without incubation with an anti-interleukin-10 monoclonal antibody . Results Mean arterial pressure increased after 10 hr by 11.8 mm Hg with treatment A and by 5.5 mm Hg with treatment B ( p = .001 ) . There was an average decrease of norepinephrine requirement of 0.08 & mgr;g/kg/min with treatment A and 0.0049 & mgr;g/kg/min with treatment B ( p = .003 ) . All patients but one survived . Spontaneous and lipopolysaccharide-induced TNF-&agr ; production from patients ’ whole blood increased over time with treatment A. This increase was more marked in blood drawn after the device ( plasmafiltrate-sorbent plus hemodialyzer ) ( p = .009 ) . Preresin plasma suppressed lipopolysaccharide-stimulated production of TNF-&agr ; by 1 × 106 cultured adherent monocytes from healthy donors . This suppressive effect was significantly reduced after passage of plasma through the resin ( p = .019 ) and after incubation with anti-interleukin-10 monoclonal antibodies ( p = .028 ) . Conclusions In patients with septic shock  , coupled plasmafiltration-adsorption combined with hemodialysis was associated with improved hemodynamics compared with continuous venovenous hemodiafiltration . This result might be related to its ability to restore leukocyte responsiveness to lipopolysaccharide . These findings suggest a potential role for blood purification in the treatment of septic shock In a prospect i ve non-r and omized trial , 59 patients with sepsis ( n = 43 ) and SIRS ( n = 16 ) were treated on a surgical intensive care unit . In 22 patients plasmapheresis in combination with continuous venovenous hemofiltration ( CVVHF ) was administered . Lethality was 56 % in the sepsis group ; in the therapy group lethality was significantly lower in patients with plasmapheresis , even though in this population the organic failure rate was higher . Finally the dependency of lethality and age was similar in both groups . Lethality at 22 % in the plasmapheresis group with double organ failure was significantly lower ( P > 0.01 ) than in controls . Reduction of lethality seemed to be as high as 18 % in patients with sepsis , while patients with SIRS did not profit from the additional therapy . A prospect i ve r and omized trial in sepsis and double organic failure should be projected Aim : The aim of this study was to observe the effects of coupled plasma filtration adsorption ( CPFA ) on septic patients with multiple organ dysfunction syndrome ( MODS ) . Methods : A total of 14 patients were r and omly divided into two groups , and , respectively , received 10 h of CPFA or high-volume hemofiltration ( HVHF ) .  The mean arterial pressure ( MAP ) , electrolytes and acid – base balance , the sequential organ failure assessment ( SOFA ) score , and the acute physiology and chronic health evaluation II ( APACHE II ) score were analyzed . Serum levels of high-mobility group box-1 ( HMGB-1 ) protein , tumor necrosis factor-α ( TNF-α ) , and intercellular adhesion molecule-1 ( ICAM-1 ) were also measured by enzyme-linked immunosorbent assay . Results : After CPFA and HVHF , temporary reduction in blood urea nitrogen and serum creatinine , electrolytes and acid – base metabolism balance were well maintained . Both the SOFA and the APACHE II scores were markedly reduced after CPFA ( p < 0.01 ) , while only the SOFA score was significantly decreased after HVHF ( p < 0.05 ) . After 10-h treatment with CPFA , the MAP and oxygen index ( PaO2/FiO2 ) were significantly higher than those at 0 h. Furthermore , the serum levels of HMGB-1 , ICAM-1 , and TNF-α decreased after 10 h of CPFA ( p < 0.05 ) , while the serum levels of HMGB-1 declined at 5 h of HVHF , but rebounded at 10 h , and the serum levels of TNF-α and ICAM-1 were no significant change after treatment with HVHF . Conclusions : The study indicated that CPFA could be superior to HVHF in improving the clinical manifestations and eliminating inflammatory mediators , which had implication s in the optimal treatment of septic patients with MODS Objective The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units ( ICUs ) . Design Prospect i ve , intention-to-treat . Setting General ICU of a tertiary care , non-teaching , 400-bed , city hospital . Patients and participants Twelve consecutive mechanically ventilated septic shock patients , with or without concomitant acute renal failure (ARF).InterventionA median of 10 consecutive sessions ( prescribed treatment time : 10 h/session ; delivered duration : 8.43±1.37 h/min ) of coupled plasmafiltration-adsorption for each patient . Measurements and results Mean arterial pressure ( 77.2±12.5 [ CI 95 % ; 74.5–79.8 ] vs. 83.3±14.1 [ CI 95 % ; 80.3–86.3 ] mm Hg ; [ p<0.001 ] ) , cardiac index ( 4.03±0.89 [ CI 95 % ; 3.83–4.22 ] vs. 3.46±0.82 [ CI 95 % ; 3.28–3.64 ] L/m2/min ; [ p<0.001 ] ) , systemic vascular resistance index ( 1,388±496 [ CI 95 % ; 1,278–1,497 ] vs. 1,753±516 [ CI 95 % ; 1,639–1,867 ] dynes × s/cm5 ; [ p<0.001 ] ) , PO2/FIO2 ratio ( 204±87 [ CI 95 % ; 185–223 ] vs. 238±82 [ CI 95 % ; 220–256 ] ; [ p<0.001 ] ) , significantly improved during 100 global treatments ( pre- vs. post-treatment values ) . Intra-thoracic blood volume and extra-vascular lung water did not change across treatments . Vasopressor requirement was reduced : norepinephrine decrease from an infusion rate of 0.13±0.07 ( CI 95 % ; 0.06–0.16 ) to 0 γ/kg/min after a mean of 5.3±2.7 sessions . C reactive protein ( CRP ) significantly decreased ( from 29.3±7.3 vs. 7.9±4.8 ; p<0.0001 ) during treatment . Survival was 90 % at day 28 and 70 % at day 90 . Conclusion Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics , the pulmonary function , and the outcome in septic shock patients with or without concomitant ARF ABSTRACT Early compliance with the sepsis resuscitation bundle has been suggested to reduce mortality . However , few data are available about the impact of late compliance with the bundle on outcomes . The aim of this study was to assess whether the completion of the resuscitation bundle within the first 6 h after admission to the intensive care unit ( ICU ) , but beyond the specific time limit of the various bundle interventions , is related to an improvement in survival . This prospect i ve , cohort study included 753 patients recruited from September 2005 until August 2010 with severe sepsis/septic shock in the three medical-surgical ICUs of a tertiary academic medical center . We assessed the compliance with the different tasks included in the resuscitation bundle . Furthermore , we ascertained within the first 6 h after ICU admission the compliance with those tasks not carried out within their specific time limits ; we have termed this variable “ bundle improvement in the ICU . ” Septic shock was present in 88.1 % . The overall in-hospital mortality was 31.6 % . In 51.5 % , there was bundle improvement in the ICU ; this variable was associated with a lower risk of mortality ( adjusted hazard ratio , 0.52 [ 95 % confidence interval , 0.34–0.78 ] ) . That association was observed only when the time from severe sepsis onset to ICU admission was 6 h or less . Importantly , similar results were found after excluding all patients with severe sepsis ( rapid responders ) and those with refractory shock ( nonresponders ) . The task with highest improvement was the achievement of central venous oxygen saturation 70 % or greater in 39 % of patients . Compliance with the resuscitation bundle even beyond the recommended time is associated with improvement in survival in patients with severe sepsis/septic shock Despite the use of potent antibiotics and intensive supportive care , the mortality among patients with sepsis and Gram-negative bacteremia remains high . In recent years , endotoxin adsorption therapy ( PMX-DHP , polymyxin-direct hemoperfusion ) has been widely used in Japan to remove endotoxin , a causative agent of sepsis . In septic patients whose clinical condition may change at any moment , the decision of when to perform blood purification in addition to conventional intensive care is a critical factor in the therapeutic strategy and prognosis . In the present study , we investigated the effect over time of PMX-DHP in sepsis . The subjects were 16 patients with systemic inflammatory response syndrome ( SIRS ) who required surgical treatment including a surgical operation and drainage . The following six parameters were compared between the first and second PMX-DHP :  mean blood pressure and time-restricted urine at four time points - at baseline and at 6 , 24 and 72 h after PMX-DHP ; and white blood cell count , platelet count , base excess and Septic Severity Score ( SSS ) at 24 and 72 h after PMX-DHP .  Mean blood pressure improved over time up to 24 h after both the first and second PMX-DHP .  Time-restricted urine volume improved only at 6 h after the first PMX-DHP .  White blood cell count improved over time up to 24 h after both the first and second PMX-DHP . The SSS improved at all time points studied except for 3 days after the second PMX-DHP . We conclude that PMX-DHP is expected to have important implication s in terms of ( i ) correction of clinical conditions ( by severity assessment ) ; ( ii ) improvement of hemodynamics ; ( iii ) possible anti-inflammatory effect ; and ( iv ) possible improvement of oxygen metabolism in tissues Severe sepsis is known to cause multiple organ failure , including renal dysfunction . During sepsis , endotoxin targets the renal proximal tubular cells , the function of which can be evaluated on the basis of urinary N-acetyl-&bgr;-glucosaminidase ( NAG ) . We investigated whether urinary NAG activity is altered in patients with severe sepsis and whether treatment with polymyxin B immobilized fibers ( PMX-F ) affects this activity . Subjects of this study were 120 patients with severe sepsis and 60 healthy volunteers matched for age and gender . Patients were r and omly assigned to one of two treatments : PMX-F treatment ( n = 70 ) or conventional treatment ( n = 50 ) . The plasma endotoxin level was significantly reduced , from 34.6 ± 10.2 to 6.8 ± 2.4 pg/ml ( p < 0.01 ) in patients treated with PMX-F , and the urinary NAG/creatinine ratio was reduced from 46.5 ± 26.8 U/gm to 18.6 ± 13.6 U/gm ( p < 0.01 ) . The plasma endotoxin level and urinary NAG/creatinine ratio were unchanged in patients who received conventional treatment . The increased urinary NAG/creatinine ratio in patients with severe sepsis may reflect proximal tubular dysfunction . PMX-F is effective in reducing proximal tubular dysfunction , in part owing to reduced plasma endotoxin levels Many kinds of blood purifying technologies have been applied to the treatment of critically ill patients since 1979 when plasma exchange with hollow-fiber membran 
    Output:
    
Evidence for CPFA in severe sepsis is sparse , of poor quality and further research is required , however , this meta- analysis noted improvements in survival rates of those patients treated with CPFA