[Hemoperfusion and plasmapheresis in the intensive care unit]

Area of Science:

• Critical Care Medicine
• Nephrology
• Infectious Diseases

Context:

• Intensive care units utilize various extracorporeal procedures beyond kidney replacement.
• Hemoperfusion with activated charcoal was historically significant but is now less relevant due to advanced dialysis.
• Current trends include cytokine adsorbers and biomimetic pathogen adsorbers, with ongoing research into their efficacy.

Purpose:

• To review the current landscape and evolving roles of different extracorporeal procedures in intensive care.
• To discuss the historical context, current applications, and future prospects of hemoperfusion, cytokine adsorbers, pathogen adsorbers, and plasmapheresis.
• To highlight the lack of robust clinical evidence for some emerging therapies and the anticipation of new data for others.

Summary:

• Hemoperfusion is largely superseded by dialysis for toxin removal.
• Cytokine adsorbers are increasingly used despite mixed study data, while pathogen adsorbers aim to reduce microbial load.
• Plasmapheresis is regaining interest for early septic shock, with key trial results expected in 2025/2026.

Impact:

• The study provides a comprehensive overview of extracorporeal therapies in critical care settings.
• It clarifies the diminishing role of older techniques and the emerging, yet sometimes unproven, applications of newer ones.
• Understanding these distinct procedures and their timing is crucial for managing bloodstream infections and sepsis.