In patients with septic shock, coupled plasmafiltration-adsorption combined with hemodialysis was associated with improved hemodynamics compared with continuous venovenous hemodiafiltration. This result might be related to its ability to restore leukocyte responsiveness to lipopolysaccharide. These findings suggest a potential role for blood purification in the treatment of septic shock.

Adsorption in sepsis. The pathophysiology of sepsis offers a ride (LPS), trigger a global response that involves both highly complicated scenario. In sepsis, endotoxin or other cellular and humoral pathways with the generation of program-positive-derived products induce a complex and dynamic inflammatory and anti-inflammatory mediators [5, 7, 8]. cellular response, giving rise to several mediators known to be These include a major group of middle molecular size relevant in the pathogenesis of septic shock such as specific (5 to 30 kD) peptides, collectively called cytokines, phosmediators, substances responsible for up-or down-regulation of cytokine receptors and cytokine antagonists, inactivators of pholipase A 2-dependent products such as platelet-actitranslational or transductional pathways, and precursor molevating factor (PAF), leukotrienes, and thromboxanes, cules. In this review, we delve into some new concepts stemand complement-derived activated products such as C3a, ming up from the use of sorbents in continuous plasma filtra-C5a, and their desarginated products. Other agents tion. Nonspecific simultaneous removal of several mediators of the inflammatory cascade have led to improved outcomes play a role in the pathophysiology of sepsis such as surin animal models of septic shock and to improved hemodynamface-expressed and soluble adhesion molecules, kinins, ics in a pilot clinical study. It seems of great importance to thrombin, myocardial depressant substance(s), ␤-endorexplore all possible treatment techniques that may have a direct phin, and heat shock proteins. In normal conditions, the impact on circulating mediators of sepsis and that also may biological activity of these mediators is under the control interfere with the imbalance between proinflammatory and anti-inflammatory substances in the critically ill patient with