Monitoring Treatment, Risks and Side Effects

Inflammation plays a key role in the pathophysiology of organ dysfunction in the critically ill patients and is triggered by an overwhelming host response resulting in the overproduction of various cytokines. Regaining immune homeostasis over the dysregulated immune response through broad removal of cytokines using extracorporeal blood purification therapies has recently gained increasing attention. Nonetheless, many questions remain regarding the appropriate monitoring treatment, its potential risks, and side effects. The CytoSorb blood purification, the most extensively investigated device, has been shown to effectively remove an array of cytokines that may lead to rapid hemodynamic stabilization as indicated by reduced vasopressor need during the treatment, as well as an improvement in vital organ function. However, reported survival benefits have been fairly inconsistent. The therapy has also been confirmed as being safe and well tolerated. Despite several questions remaining such as the right timing, duration, frequency, concomitant antibiotic use, and most appropriate patient group with the highest change of benefit, the additional use as adjuvant therapy in hyperinflammatory states and/or in patients refractory to best standard care seems reasonable. Of note, there are several randomized controlled trials currently registered and ongoing that hopefully will provide answers to some of the above questions in the not-too-distant future.