Unraveling the secret of re-balancing homeostasis in sepsis: a critical view on extracorporeal blood purification modalities

Clinical and biochemical endpoints and predictors of response to plasma exchange in septic shock: results from a randomized controlled trial

“…The absence of a third therapeutic arm testing plasma exchange with albumin as replacement fluid, prevents to draw conclusions concerning the underlying reason for the beneficial effects seen in terms of hemodynamic stabilization, e.g., due to removal of injurious mediators or replacement with protective factors. However, it might be possible that exactly the combination of both principles might be important for restoration of hemostasis in septic shock [ 57 ]. The use of lactate as a parameter to predict response to treatment was not proposed a-priori.…”

The phenomenon of desorption: What are the best adsorber exchange intervals?

“…The recently published data of an ESICM survey demonstrated, that CytoSorb is the most commonly used extracorporeal blood purification technique by European intensivists [4]. Nevertheless data on how to decide on adsorber exchange intervals is scarce so far and different approaches have been described.…”

Bridging patients with acute-on-chronic liver failure for transplantation: plasma exchange to stabilize multiorgan failure?

“…Therapeutic plasma exchange (TPE) is an extracorporeal strategy utilizing a profoundly different biological approach than the adsorptive strategies, which are all centered at removing injurious mediators. The rationale behind TPE rather follows the idea of combining, such as the removal of excessive injurious mediators with the replacement of diminished protective factors (Table 1 ) [ 3 ].…”

“…Our group could demonstrate in patients with septic shock, that TPE effectively removes proinflammatory cytokines, endothelial- and glycocalyx destabilizing factors (e.g., angiopoietin-2, heparanase-1) as well as molecules involved in intravascular clotting and disturbance of the microcirculation (von Willebrand factor antigen, D-dimers) [ 3 ]. At the same time, the exchange of septic plasma with that from healthy donors leads to a replenishment of protective but depleted factors involved in anti-inflammatory processes (immunoglobulins), in endothelial stabilization (angiopoietin-1, heparanase-2) and in anti-coagulation (antithrombin-III, protein C, ADAMTS-13) [ 3 ]. In a recent trial, additive TPE was associated with rapid hemodynamic improvement in patients with severe refractory septic shock [ 4 ].…”