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Updated: Jul 28, 2025
Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
Published on: July 31, 2016
Hemoperfusion: Indications, Dose, Prescription
Frank Bidar1,2, Stanislas Abrard1,3, Antoine Lamblin1
1Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
Recent advances in the development of sorbent materials have enabled the development of hemoperfusion (HP). However, HP dose and prescription are not standardized and there is no consensus in clinical practice guidelines. Adequate prescription and modality are of utmost importance to ensure HP effectiveness. Although the main indication of CytoSorb®, HA330/380, polymyxin B, and Seraph® is sepsis, these devices may be beneficial in many other situations such as liver failure, rhabdomyolysis, pancreatitis, cardiopulmonary bypass, extensive burns, and trauma or to ensure antiplatelet therapy drug removal. They can be applied as stand-alone therapies or combined with renal replacement therapy. The usual prescribed blood flow varies between 100 and 700 mL/min. CytoSorb® sessions usually last 24 h and may be repeated up to 7 days, whereas HA330/380, polymyxin B, and Seraph® sessions usually last between 2 and 4 h and are repeated up to 3 days. Current clinical data are lacking to establish the optimal operating conditions of HP and studies focusing on defining the optimal timing, dose, and duration of these therapies could help define future clinical applications.
Recent advances in the development of sorbent materials have enabled the development of hemoperfusion (HP). However, HP dose and prescription are not standardized and there is no consensus in clinical practice guidelines. Adequate prescription and modality are of utmost importance to ensure HP effectiveness. Although the main indication of CytoSorb®, HA330/380, polymyxin B, and Seraph® is sepsis, these devices may be beneficial in many other situations such as liver failure, rhabdomyolysis, pancreatitis, cardiopulmonary bypass, extensive burns, and trauma or to ensure antiplatelet therapy drug removal. They can be applied as stand-alone therapies or combined with renal replacement therapy. The usual prescribed blood flow varies between 100 and 700 mL/min. CytoSorb® sessions usually last 24 h and may be repeated up to 7 days, whereas HA330/380, polymyxin B, and Seraph® sessions usually last between 2 and 4 h and are repeated up to 3 days. Current clinical data are lacking to establish the optimal operating conditions of HP and studies focusing on defining the optimal timing, dose, and duration of these therapies could help define future clinical applications.
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