Methods of Extracorporeal Hemocorrection in Sepsis (Review)

Abstract

Sepsis and septic shock remain a major problem in critical care medicine being the most common causes of death in the intensive care unit. Currently, such methods of extracorporeal blood purification as hemodiafiltration, high-volume hemofiltration, high cut-off (HCO) membrane hemofiltration are among preferable options for treatment of severe systemic disorders and pathological conditions including sepsis.The purpose of the review is to show the potentialities and prospects of the use of various extracorporeal hemocorrection methods, including those that are commonly employed in medical practice, and novel ones, either recently developed, or still under the development in experimental settings according to sepsis patho-physiology. The selected 82 papers represent comprehensible clinical and experimental data from the literature of the last five years and several earlier publications remained of current interest in a medical practice.The review presents current methods of extracorporeal hemocorrection (EHC) in patients with sepsis. The clinical pathophysiology of sepsis is described in relation to treatment options that target endotoxemia and «cytokine storm». We consider commonly used EHC methods (hemodiafiltration, high-volume hemofiltration, high cut-off membrane hemofiltration and others) and novel promising technologies that include extracorporeal kidney support device, immune support system, leukocyte inhibition module, and artificial spleen, which have been recently developed and are still under investigation in the intensive care.Conclusion. Currently, EHC methods are increasingly used not only to support renal function, but also as pathogenetic therapy option for multiple organ support and immunomodulation by reducing the level of cir-culating inflammatory mediators. Exploration of novel extracorporeal blood purification techniques for the pathogenetic treatment of patients with sepsis seems encouraging and promising.

Septic Hyperinflammation—Is There a Role for Extracorporeal Blood Purification Techniques?

“… Blood purification techniques: Introduced in this stage for patients with refractory shock and/or significant organ dysfunction, aimed at removing excessively elevated inflammatory mediators and toxins. Blood purification techniques are considered adjunctive therapies and are typically reserved for cases where conventional treatments fail to stabilize the patient or when there is evidence of overwhelming inflammation contributing to organ dysfunction [ 6 ]. Their use is guided by the severity of sepsis, the patient’s response to initial treatments, and the presence of complications such as severe metabolic derangements or refractory shock.…”