[Extracorporeal techniques for blood purification in sepsis: an update]

Area of Science:

• Critical Care Medicine
• Nephrology
• Immunology

Background:

• Sepsis continues to have high mortality rates despite advancements.
• Extracorporeal cytokine removal techniques have been explored, but evidence is inconsistent.

Purpose of the Study:

• To review current extracorporeal blood purification methods for sepsis.
• To evaluate the existing evidence for their efficacy in cytokine removal and patient outcomes.

Main Methods:

• A non-systematic literature review was conducted.
• Various blood purification techniques were examined, including high-volume dialysis, adsorption filters (e.g., CytoSorb®, polymyxin-B), and therapeutic plasma exchange.

Main Results:

• Evidence for cytokine removal, vasopressor sparing, and mortality reduction varies among techniques.
• Some methods, like combined plasma filtration and adsorption, have shown negative impacts on survival in randomized trials.

Conclusions:

• Blood purification methods lack sufficient evidence for routine recommendation in sepsis management.
• Heterogeneity in sepsis responses complicates clinical trial design.
• Future research should focus on specific sepsis subtypes, and current techniques should be considered individualized, complementary treatments.