Haemoadsorption to remove inflammatory mediators in sepsis: past, present, and future

Area of Science:

• Critical Care Medicine
• Immunology
• Nephrology

Background:

• Sepsis is characterized by a dysregulated immune response.
• Standard sepsis care focuses on antimicrobials, source control, resuscitation, and organ support.
• Extracorporeal blood purification, specifically haemoadsorption, is explored as an adjunctive therapy.

Purpose of the Study:

• To review current haemoadsorption devices for sepsis.
• To introduce a novel selective adsorption device, the 'IL-6-Sieve'.
• To discuss future research directions for haemoadsorption in septic patients.

Main Methods:

• Narrative review of existing literature on haemoadsorption in sepsis.
• Description of well-studied haemoadsorption devices.
• Presentation of in vitro data for the 'IL-6-Sieve' device.

Main Results:

• Haemoadsorption aims to mitigate sepsis by removing inflammatory mediators like cytokines and endotoxins.
• The 'IL-6-Sieve' shows in vitro potential for capturing specific mediators.
• Current evidence is insufficient to justify routine haemoadsorption use, despite its use in some centers.

Conclusions:

• Haemoadsorption is a potential adjunctive therapy for sepsis, targeting immune dysregulation.
• Further well-designed clinical trials are crucial to establish the efficacy and safety of haemoadsorption in severe septic shock.
• Considerations for future trials include patient selection and outcome measures.