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[Extracorporeal procedures in sepsis].

Alice Bernard, Michael Koeppen1

  • 1Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland. Michael.koeppen@med.uni-tuebingen.de.

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Summary
This summary is machine-generated.

Extracorporeal procedures for sepsis, like hemofiltration and cytokine adsorption, aim to remove inflammatory mediators but lack proven survival benefits. Further research is needed to determine their efficacy and safety in treating sepsis patients.

Keywords:
Extracorporeal techniquesHemofiltrationHemoperfusionPlasma exchangeSeptic shock

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Area of Science:

  • Intensive care medicine
  • Immunology
  • Nephrology

Background:

  • Sepsis and septic shock are life-threatening conditions resulting from a dysregulated immune response to infection.
  • These conditions are prevalent in intensive care units and associated with high mortality rates.

Purpose of the Study:

  • To provide an overview of various extracorporeal procedures used in treating sepsis and septic shock.
  • To evaluate the current evidence regarding the efficacy and safety of these treatments.

Main Methods:

  • Review of extracorporeal procedures including high-volume hemofiltration (HVHF), very high-volume hemofiltration (VHVHF), high cut-off (HCO) filters, polymyxin B hemoperfusion, and cytokine adsorption filters.
  • Inclusion of combined plasma filtration and adsorption (CPFA) and therapeutic plasma exchange (TPE).

Main Results:

  • HVHF and VHVHF remove inflammatory mediators but do not significantly improve sepsis patient stabilization or survival.
  • HCO filters remove cytokines, but survival benefits are unproven. Polymyxin B hemoperfusion shows promise in specific groups, while evidence for cytokine adsorption filters is limited.
  • CPFA shows no survival benefit; TPE may offer vascular glycocalyx protection. All procedures carry risks like thrombosis and loss of essential proteins.

Conclusions:

  • The therapeutic benefit of current extracorporeal procedures for sepsis remains unclear.
  • Further large-scale, randomized, multicenter studies are essential to establish efficacy and safety.
  • No current guideline recommendations support the routine use of these procedures for sepsis treatment.