Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements

Table 1 Studies showing efficacy of different devices for cytokine and endotoxin removal

Ref.	Study type	Population	Modality	Intervention	Outcomes
Tapia et al[28], 2012	Prospective cohort study	31 severe septic shock patients	HVHF, Cytokine removal	HVHF – single short term – 6 h at 40 mL/kg/h	25/31 responded to HVHF. Decrease in NE dose and improvement in hemodynamic, metabolic and respiratory parameters were significantly improved by 4 h
Joannes-Boyau et al[29], 2013	Prospective, randomized, open multicentre trial	137 septic shock patients (AKI < 24 h)	HVHF, Cytokine removal	HVHF – 70 mL/kg/h vs standard volume hemofiltration at 35 mL/kg/h	No difference in hemodynamic stability, severity scores, 28-d mortality, length of stay and vasopressor free days
Livigni et al[30], 2014	Prospective, randomized, multicentre parallel group trial	192 septic shock patients	CPFA, Cytokine & endotoxin removal	Conventional therapy (n = 93) vs CPFA (n = 91)	Decreased mortality in patients receiving high dose of CPFA. No difference in length of ICU stay and new organ failures in 30 d
Atan et al[31], 2018	Randomized controlled trial	76 critically ill patients with AKI	CVVH -HCOCytokine removal	CVVH-HCO (n = 38) – cut off point 100 kDa vs CVVH -Std (n = 38) – cut off point 30 kDa	No difference was observed in mortality, duration of hemofiltration, norepinephrine dose, serum albumin levels and filter life
Dellinger et al[32], 2018	Randomized, multicentre trial	449 septic shock patients	Polymyxin B hemoperfusion; Endotoxin removal	Polymyxin B hemoperfusion + Standard therapy vs Sham hemoperfusion + Standard therapy	No significant difference in 28 d mortality in overall population or in patients with MODS score of > 9
Kaçar et al[33], 2020	Prospective observational study	23 septic shock patients with AKI	HA 330 Cytokine removal	HA 330 hemoperfusion + CVVH for 2 h once daily for 3 d	Increase in pH was observed after 1st application HA330 hemoperfusion; CRP and PCT levels decreased significantly after 2nd application

HVHF: High volume hemoperfusion; CPFA: Coupled plasma filtration adsorption; CVVH: Continuous veno-venous hemoperfusion; HCO: High cut off membrane; ICU: Intensive care unit; NE: Norepinephrine; AKI: Acute kidney injury; CRP: C-reactive protein; PCT: Procalcitonin.