New directions of scientific research and clinical practice in the field of extracorporeal hemocorrection in patients with multiple organ dysfunction: a review

Abstract

INTRODUCTION: Due to the COVID-19 (infectious disease caused by the SARS-CoV-2 virus) pandemic, we had to take a completely different approach to the nature of critical conditions. The pandemic also made us reconsider many views about it. Moreover, that contributed to the development of new practical approaches for treatment and prevention, including the ones in the field of extracorporeal hemocorrection. OBJECTIVE: Methods for purification of blood and plasma began to be considered as an independent link for the treatment of organ disorders or as a part of extracorporeal support for the life support of the body. MATERIALS AND METHODS: The article consists of three sections: a description of the role of extracorporeal hemocorrection methods in intensive care, their classification and main characteristics; the concept of sequential targeted extracorporeal therapy for a treatable symptom in sepsis; extracorporeal hemocorrection as part of the concept of extracorporeal life support. This article uses literary sources published from January 1, 2022 to July 1, 2023. Materials related to COVID-19 and other specific pathologies (poisoning, acute liver failure, itching, systemic diseases, etc.), requiring separate discussion, are intentionally excluded. RESULTS: Technologies in extracorporeal hemocorrection provide support and/or replacement of organ functions; restoration of body resistance and balance between inflammatory and anti-inflammatory response; restoration of body tolerance (metabolism and regeneration). Nevertheless, despite the convincing pathophysiological rationale for the use of these methods in critical conditions, evidence of its effectiveness is limited. Current trends indicate that future research should be primarily aimed at finding biomarkers that can simultaneously designate specific biological processes; characterize different subgroups of patients; allow targeted choice for the method of therapy. The modulation of biomarkers under the influence of this therapy can show its effectiveness for this particular subgroup of patients at this stage of the disease. CONCLUSIONS: Methods of extracorporeal blood purification should be aimed at prevailing biological processes, at this stage of pathogenesis, and, accordingly, evaluated by the effectiveness of the impact on these processes.