The researches find that the sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. They performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. sepsis remains one of the main causes of morbidity and mortality in the intensive care unit. Despite recent advancement in intensive care unit and sepsis management, mortality still remains high.
Extracorporeal blood purification
The pathogenesis of sepsis involves many complex cellular and biochemical interactions between leukocytes, platelets, endothelial cells; and the complement system that trigger an inflammatory response. Inflammation is cause by the production of pro- and antiinflammatory mediators, such as cytokines; in the presence of infection and/or bacterial toxins; and the imbalance between these mediators or their excessive production may lead to multiorgan failure due to a prolonged or inadequate systemic inflammatory response syndrome.
Extracorporeal blood purification techniques have been propose as adjunctive therapy in sepsis. These techniques are based on the principle that removal and modulation of blood pro- and antiinflammatory mediators or bacterial toxins (or both) could attenuate the sepsis-related massive systemic inflammatory response; reducing morbidity and mortality. Several different extracorporeal techniques have been studied for this purpose. Hemoperfusion involves the placement of a sorbent cartridge in direct contact with blood via an extracorporeal circuit.
Massive systemic inflammatory
The removal characteristics of hemoperfusion are dependent on the different types of sorbent used and also target high-molecular-weight molecules; usually not capture by conventional hemofilters. The most studied therapy is polymyxin B immobilized fiber column hemoperfusion with Toraymyxin (Toray Industries Ltd., Japan); that could capture circulating bacterial endotoxin and modulate the inflammatory response. Another device is the CytoSorb (CytoSorbents Corporation, USA); a novel filter potentially able to remove both pro-inflammatory and antiinflammatory cytokines.
Renal replacement devices such as hemofiltration or hemodiafiltration use to remove part of the inflammatory mediators and toxins in septic patients without renal indication for kidney replacement therapy; by employing standard or special filters with adsorptive properties. Limited data are available on plasmapheresis, a technique based on plasma replacement with fresh frozen plasma or albumin; that has the potential to remove inflammatory cytokines and restore deficient plasma proteins. Despite the large number of available techniques; actual evidence is scarce, and these therapies have not entered into daily clinical practice around the world yet. Several small trials were publish on various devices, and the most comprehensive meta-analysis summarizing the evidence on blood purification is outdate.