Hemoperfusion in the intensive care unit

Abstract

Multiple organ failure following a septic event derives from immune dysregulation. Many of the mediators of this process are humoral factors (cytokines), which could theoretically be cleared by direct adsorption through a process called hemoperfusion. Hemoperfusion through devices, which bind specific molecules like endotoxin or theoretically provide non-specific adsorption of pro-inflammatory mediators has been attempted and studied for several decades with variable results. More recently, technological evolution has led to the increasing application of adsorption due to more biocompatible and possibly more efficient biomaterials. As a result, new indications are developing in this field, and novel tools are available for clinical use. This narrative review will describe current knowledge regarding technical concepts, safety, and clinical results of hemoperfusion. Finally, it will focus on the most recent literature regarding adsorption applied in critically ill patients and their indications, including recent randomized controlled trials and future areas of investigation.

Targeting circulating high mobility group box-1 and histones by extracorporeal blood purification as an immunomodulation strategy against critical illnesses

“…Currently, EBP uses a series of hemofilters to remove hydrophilic or hydrophobic solutes through the mechanism of convection, diffusion or adsorption, and the solute removal spectrum of a hemofilter is significantly dependent on its own membrane/adsorbent structure and treatment dose [ 6 ]. Multiple hemofilters, such as Toraymyxin hemofilter (Toray Industries, Tokyo, Japan), the CytoSorb hemofilter (CytoSorbents Corporation, New Jersey, USA) and the oXiris hemofilter (Baxter, Meyzieu, France), have been used to treat critically ill patients in current clinical practice aiming to eliminate endotoxins and/or cytokines despite the lack of solid evidence of survival benefit [ 3 , 7 ]. The failure of EBP therapies to improve survival in these patients could be attributed to the inadequate timing for treatment initiation, inadequate patient selection, inadequate therapeutic target selection and insufficient clearance of inflammatory mediators [ 3 , 5 ].…”

Effect of Blood Hemoperfusion Therapy in Acute Type A Aortic Dissection Surgery：a retrospective observational study

“…Extracorporeal cytokine adsorption, known as hemoadsorption, using materials with high adsorptive capacity applied to a number of disorders [1].The HA-380 cartridge is a novel hemoadsorption device that contains neutral macroporous beads, and is capable of removing 10 to 60 kDa molecules from blood including various cytokines [3]. IL-6 has been identi ed as a diagnostic tool, and frequently as a potential clinical target of hemoperfusion treatment [27]. Another in ammation biomarker CRP, an acute-phase protein regulated by pro-in ammatory cytokines, were higher in aortic dissection and independently associated with worse short-term mortality and poor prognosis [28,29].…”

Vasoplegic Syndrome after Cardiopulmonary Bypass in Cardiovascular Surgery: Pathophysiology and Management in Critical Care

“…This strategy has been applied to decrease inflammation in sepsis, with promising results reported in a number of case reports and case series. However, prospective RCTs failed to report any mortality benefit, some of them showing instead potential harmful effects possibly related to the unselective removal of anti-inflammatory mediators and drugs, notably antibiotics (see: [ 146 ] for extensive review on this topic).…”