Is There a Place for Apheresis in Patients with Severe Sepsis or Multi Organ Dysfunction Syndrome?

Severe sepsis and multiorgan dysfunction syndrome may develop in the course of severe sepsis, intoxication, poisoning, crush injury, asystole, drowning, and several other complications. When normal intensive care is insufficient despite vasoactive drugs, respiratory aid, and dialysis, the risk for death is extremely high. Only very little benefit has been noted in various trials using drug administration such as antibodies against TNF-alfa, immunoglobulin, pentoxifylline and high dose steroids. The use of apheresis (plasma exchange, plasmapheresis, adsorption) to remove toxins, cytokines, and other compounds has been tried in an unselective as well as selective manner. Data now exists that indicate increased survival by this type of therapy. It is time to focus on randomised controlled trials with these techniques to decide the efficacy of apheresis in this area.