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[Adsorption therapy in sepsis].

D Hasper1, J C Schefold, A Jörres

  • 1Klinik für Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland, dietrich.hasper@charite.de.

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Extracorporeal mediator adsorption shows promise for sepsis treatment by removing inflammatory substances. However, clinical studies are needed to confirm improved patient outcomes before widespread use.

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Area of Science:

  • Critical care medicine
  • Biomedical engineering
  • Immunology

Background:

  • Sepsis involves complex pro- and anti-inflammatory mediator activation.
  • These mediators contribute to organ dysfunction and disease severity in sepsis.
  • Current therapeutic options to modulate these mediators are limited.

Purpose of the Study:

  • To evaluate the feasibility and potential of extracorporeal mediator adsorption in sepsis.
  • To discuss available technologies for mediator adsorption, including exclusive systems and those integrated with renal replacement therapy.
  • To highlight the different adsorption mechanisms, from broad unspecific binding to specific endotoxin or mediator capture.

Main Methods:

  • Review of current technical innovations in extracorporeal mediator adsorption systems.
  • Analysis of systems offering exclusive mediator removal versus those combined with renal replacement therapy.
  • Examination of membrane properties for broad or specific mediator adsorption.

Main Results:

  • Biochemical efficacy of some mediator adsorption systems has been demonstrated.
  • Various technologies are available, differing in their adsorption specificity and integration with other therapies.
  • No controlled clinical studies currently prove improved patient outcomes.

Conclusions:

  • Extracorporeal mediator adsorption is technically feasible with available systems.
  • While biochemical effects are shown, clinical benefits remain unproven.
  • Use outside clinical trials is not recommended due to lack of evidence for improved clinical endpoints.