Published online Mar 9, 2023. doi: 10.5492/wjccm.v12.i2.71
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
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.
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.
To analyze new research on ECT use in sepsis and evaluate its impact on key inflammatory and clinical outcomes.
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.
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.
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.
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.