111 CONCLUSIONI
Pur sottolienando che la ridotta dimensione e l’eterogenità del campione associata all’eterogenieità della stessa condizione settica richiedano un’ampliamento della popolazione in studio, possiamo dire che:
-il sistema immunitario si conferma essere un importante protagonista nella fisiopatologia settica, per cui monitorare lo stato immunitario del paziente per individuare lo shift verso l’immunoparalisi può essere una guida utile per le scelte terapeutiche. Nonostante l’attuale povertà di terapie immunostimolanti indicate nel paziente settico (immunoglobuline, fattori di crescita, ..) l’identificazione di deficit immuntari specifici può indirizzare verso un sospetto diagnostico più mirato. L’assenza di un unico marker abbastanza sensibile e specifico ci porta a scegliere un monitoraggio multiparametrico. In questa direzione la citofluorimetria point of care potrebbe risultare utile.
-la coagulopatia settica è una condizione frequente che se identificata precocemente, e questo è facile e possibile con metodiche point of care come il TEG, può guidare il clinico nella scelta della terapia.
-Il dosaggio dell’endotossinemia mendiante EAA™ consente l’identificazione rapida di pazienti con infezioni da batteri gram negativi, che possono essere solo sospettati clinicamente in presenza di emocolture in corso o negative, permettendo al clinico di iniziare una terapia antibiotica più mirata seppur empirica e/o tecniche di
112
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