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Review
. 2018 Oct 25;22(1):262.
doi: 10.1186/s13054-018-2181-z.

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

Ghada Ankawi  1   2 , Mauro Neri  3   4 , Jingxiao Zhang  3   5 , Andrea Breglia  3   6 , Zaccaria Ricci  7 , Claudio Ronco  3   4
Affiliations
Review

Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

Ghada Ankawi et al. Crit Care. .

Abstract

Sepsis is one of the leading causes of morbidity and mortality worldwide. It is characterized by a dysregulated immune response to infections that results in life-threatening organ dysfunction and even death. Bacterial cell wall components (endotoxin or lipopolysaccharide), known as pathogen-associated molecular patterns (PAMPs), as well as damage-associated molecular patterns (DAMPs) released by host injured cells, are well-recognized triggers resulting in the elevation of both pro-inflammatory and anti-inflammatory cytokines. Understanding this complex pathophysiology has led to the development of therapeutic strategies aimed at restoring a balanced immune response by eliminating/deactivating these inflammatory mediators. Different extracorporeal techniques have been studied in recent years in the hope of maximizing the effect of renal replacement therapy in modulating the exaggerated host inflammatory response, including the use of high volume hemofiltration (HVHF), high cut-off (HCO) membranes, adsorption alone, and coupled plasma filtration adsorption (CPFA). These strategies are not widely utilized in practice, depending on resources and local expertise. The literature examining their use in septic patients is growing, but the evidence to support their use at this stage is considered of low level. Our aim is to provide a comprehensive overview of the technical aspects, clinical applications, and associated side effects of these techniques.

Keywords: Acute kidney injury; Adsorption; Coupled plasma filtration adsorption; Extracorporeal technique; High cut-off membranes; High volume hemofiltration; Renal replacement therapy; Sepsis.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Circuit components in high volume hemofiltration (HVHF) and very high volume hemofiltration (VHVHF). Arterial line (red), ultrafiltrate (yellow), replacement fluid (purple), and venous line (blue)
Fig. 2
Fig. 2
Circuit components using high cut-off membranes. Arterial line (red), ultrafiltrate (yellow), dialysate (green), and venous line (blue)
Fig. 3
Fig. 3
Circuit components in adsorption. Arterial line (red) and venous line (blue)
Fig. 4
Fig. 4
Circuit components in coupled plasma filtration adsorption (CPFA). Arterial line (red), plasma (yellow, pre-hemofilter), ultrafiltrate (yellow, post-hemofilter), replacement fluid (purple), and venous line (blue)
See this image and copyright information in PMC

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