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Review
. 2023 Mar 9;12(2):71-88.
doi: 10.5492/wjccm.v12.i2.71.

Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

Yatin Mehta  1 , Rajib Paul  2 , Abdul Samad Ansari  3 , Tanmay Banerjee  4 , Serdar Gunaydin  5 , Amir Ahmad Nassiri  6 , Federico Pappalardo  7 , Vedran Premužić  8 , Prachee Sathe  9 , Vinod Singh  10 , Emilio Rey Vela  11
Affiliations
Review

Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

Yatin Mehta et al. World J Crit Care Med. .

Abstract

Background: Despite various therapies to treat sepsis, it is one of the leading causes of mortality in the intensive care unit patients globally. Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies (ECT) which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators.

Aim: To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes.

Methods: In this review, an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis. A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts.

Results: Results showed that ECT techniques such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, and CytoSorb® are emerging as adjunct therapies to improve hemodynamic stability in sepsis. CytoSorb® has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores, lactate levels, total leucocyte count, platelet count, interleukin- IL-6, IL-10, and TNF levels.

Conclusion: Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials. In addition to patient-tailored therapies, future research developments with therapies targeting the cellular level of the immune response are expected.

Keywords: CytoSorb®; Extracorporeal therapies; Hemadsorbers; Inflammatory mediators; Sepsis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA diagram. ECT: Extracorporeal therapies.
Figure 2
Figure 2
Pathophysiology of sepsis. ATP: Adenosine triphosphate; DAMP: Damage associated molecular pattern.
Figure 3
Figure 3
Treatment algorithm for sepsis-screening to intensive care unit management. SIRS: Systemic Inflammatory Response Syndrome; NEWS: National Early Warning Score; MEWS: Modified Early Warning Score; qSOFA: Quick Sequential Organ Failure Assessment; Temp: Temprature; HR: Heart rate, RR: Respiratory rate; TLC: Total leukocyte count; MAP: Mean arterial pressure; PPV: Pulse pressure variation; SI: Stroke index.
See this image and copyright information in PMC

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