Adjunctive Hemoadsorption Therapy with CytoSorb in Patients with Septic/Vasoplegic Shock: A Best Practice Consensus Statement

Abstract

A dysregulated host response is a common feature in critically ill patients due to both infectious and non-infectious origins that can lead to life-threatening organ dysfunction, which is still the primary cause of death in intensive care units worldwide. In its course, pathologic, unregulated levels of inflammatory mediators are often released into the circulation, a phenomenon also referred to as a "cytokine storm". To date, there are no approved therapies to modulate the excessive immune response and limit hyperinflammation with the goal of preventing related organ failure and death. In this context, extracorporeal blood purification therapies aiming at the alteration of the host inflammatory response through broad-spectrum, non-selective removal of inflammatory mediators have come into focus. A novel hemoadsorption device (CytoSorb^®, CytoSorbents Inc., Princeton, NJ, USA) has shown promising results in patients with hyperinflammation from various origins. Although a significant body of literature exists, there is ongoing research to address many important remaining questions, including the optimal selection of patient groups who might benefit the most, optimal timing for therapy initiation, optimal schedule for adsorber exchanges and therapy duration, as well as an investigation into the potential removal of concomitant antibiotics and other medications. In this review, we discuss the existing evidence and provide a consensus-based best practice guidance for CytoSorb^® hemoadsorption therapy in patients with vasoplegic shock.

Keywords: CytoSorb therapy; hemoadsorption; hyperinflammation; septic shock; shock; vasoplegic shock.

Figure 1

Therapeutic Concepts in Sepsis and Septic Shock—Dilemma and Challenge. MABs, monoclonal antibodies. RRT, renal replacement therapy. MODS, multiple organ dysfunction syndrome. SMT, standard medical therapy. SSC, surviving sepsis campaign. PAMPs, pathogen-associated molecular patterns. DAMPs, damage-associated molecular patterns.