Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2023; 12(2): 71-88
Published online Mar 9, 2023. doi: 10.5492/wjccm.v12.i2.71
Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements
Yatin Mehta, Rajib Paul, Abdul Samad Ansari, Tanmay Banerjee, Serdar Gunaydin, Amir Ahmad Nassiri, Federico Pappalardo, Vedran Premužić, Prachee Sathe, Vinod Singh, Emilio Rey Vela
Yatin Mehta, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Gurugram 12201, India
Rajib Paul, Department of Internal Medicine, Apollo Hospitals, Jubilee Hills, Hyderabad 500033, India
Abdul Samad Ansari, Department of Critical Care, Nanavati Max Super Specialty Hospital, Mumbai 400065, India
Tanmay Banerjee, Department of Internal Medicine & Critical Care, Medica Institute of Critical Care Medicine, Medica Superspecialty Hospital, Kolkata 700099, India
Serdar Gunaydin, Department of Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital Campus, Ankara 06933, Turkey
Amir Ahmad Nassiri, Department of Nephrology, Shahid Beheshti University of Medical Sciences, Tehran 19839-63113, Iran
Federico Pappalardo, Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria 15121, Italy
Vedran Premužić, Department of Nephrology, Clinical Hospital Zagreb, Clinic for internal diseases, Zagreb 10000, Croatia
Prachee Sathe, Department of Critical Care Medicine, D.Y. Patil Medical College, Sant Tukaram Nagar, Pimpri Colony, Pimpri-Chinchwad, Pune 411018, India
Vinod Singh, Department of Critical Care Medicine, Institute of critical care Medicine, Hospital Name - Sir Ganga Ram Hospital, New Delhi 110001, India
Emilio Rey Vela, Cardiac Surgery Intensive Care Unit, Samaritan University Hospital, Bogotá 11, Colombia
Author contributions: The above all authors have equally contributed towards ideation, data analysis and manuscript review.
Conflict-of-interest statement: All the authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yatin Mehta, MBBS, MD, Chairman, Institute of Critical Care and Anesthesiology, Medanta the Medicity, Sector 38, Gurugram 12201, India. yatin.mehta@medanta.org
Received: November 22, 2022
Peer-review started: November 22, 2022
First decision: December 26, 2022
Revised: January 5, 2023
Accepted: February 17, 2023
Article in press: February 17, 2023
Published online: March 9, 2023
Processing time: 104 Days and 15.4 Hours
Abstract
BACKGROUND

Despite various therapies to treat sepsis, it is one of the leading causes of mortality in the intensive care unit patients globally. Knowledge about the pathophysiology of sepsis has sparked interest in extracorporeal therapies (ECT) which are intended to balance the dysregulation of the immune system by removing excessive levels of inflammatory mediators.

AIM

To review recent data on the use of ECT in sepsis and to assess their effects on various inflammatory and clinical outcomes.

METHODS

In this review, an extensive English literature search was conducted from the last two decades to identify the use of ECT in sepsis. A total of 68 articles from peer-reviewed and indexed journals were selected excluding publications with only abstracts.

RESULTS

Results showed that ECT techniques such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, and CytoSorb® are emerging as adjunct therapies to improve hemodynamic stability in sepsis. CytoSorb® has the most published data in regard to the use in the field of septic shock with reports on improved survival rates and lowered sequential organ failure assessment scores, lactate levels, total leucocyte count, platelet count, interleukin- IL-6, IL-10, and TNF levels.

CONCLUSION

Clinical acceptance of ECT in sepsis and septic shock is currently still limited due to a lack of large random clinical trials. In addition to patient-tailored therapies, future research developments with therapies targeting the cellular level of the immune response are expected.

Keywords: CytoSorb®; Hemadsorbers; Inflammatory mediators; Extracorporeal therapies; Sepsis

Core Tip: Sepsis is one of the leading causes of mortality in critically ill patients globally. Substantial progress is made in the field of extracorporeal therapies and sepsis. CytoSorb® is emerging as an adjunct therapy to improve hemodynamic stability. This device is an International Organization for Standardization certified, European Conformité Européenne mark-approved class IIb medical device that is designed to remove excess inflammatory cytokines from the blood. There are extensive published reports of its use in the field of septic shock with improved survival rates and other improved biochemical parameters. However, clinical acceptance is still limited due to a lack of large random clinical trials.