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
ARTICLE HIGHLIGHTS
Research background

Sepsis is one of the main causes of mortality in patients in critical care units worldwide, despite the fact that it can be treated with a variety of medications. Extracorporeal treatments (ECT), which aim to balance the dysregulation of the immune system by eliminating high quantities of inflammatory mediators, have drawn attention as a result of knowledge about the biology of sepsis.

Research motivation

The biology of sepsis has brought attention to extracorporeal therapies (ECT), which try to regulate immune system dysregulation by removing large amounts of inflammatory mediators.

Research objectives

To analyze new research on ECT use in sepsis and evaluate its impact on key inflammatory and clinical outcomes.

Research methods

To find the usage of ECT in sepsis, a thorough search of the English literature from the previous two decades was done for this review. The selection process excluded publications that had only abstracts and resulted in a total of 68 articles from peer-reviewed and indexed journals.

Research results

The findings demonstrated the emergence of ECT approaches such as high-volume hemofiltration, coupled plasma adsorption/filtration, resin or polymer adsorbers, and CytoSorb® as adjuvant therapy to enhance hemodynamic stability in sepsis. With findings on increased survival rates and decreased sequential organ failure assessment scores, lactate levels, total leucocyte count, platelet count, interleukin-IL-6, IL-10, and TNF levels, CytoSorb® has the most published evidence in relation to its usage in the field of septic shock.

Research conclusions

The absence of significant random clinical trials currently limits the clinical adoption of ECT in sepsis and septic shock. Future research breakthroughs with treatments aiming at the cellular level of the immune response are anticipated, in addition to patient-tailored medicines.

Research perspectives

To achieve more consistent treatment outcomes, future clinical trials involving patients with sepsis should be as homogeneous as feasible and focus on patient phenotypes and endotypes, including biomarker-based techniques. This will not only increase our grasp of how to handle proper therapy, but it will also lessen the possibility of inconsistency.