Efficacy of enhanced intensity PMMA-CHDF for refracrory septic shock and the future of blood purification for controlling mediators

Abstract

Cytokines and various mediators play pivotal roles in the pathophysiology of severe sepsis/septic shock. Continuous hemodiafiltration (CHDF) using a polymethylmethacrylate (PMMA) membrane hemofilter (PMMA-CHDF) removes cytokines efficiently and continuously mainly through adsorption onto a hemofilter membrane, thereby giving a favorable outcome. Further, we have occasionally encountered cases of refractory septic shock, and we have reported that “enhanced intensity PMMA-CHDF” may contribute to improved hemodynamics and intensive care unit (ICU) survival rate by enhancing cytokine removal. We reviewed various modalities of acute blood purification for controlling mediators, and we believe that the clinical efficacy and usefulness of PMMA-CHDF is higher than that of other modalities. Earlier introduction of enhancing intensity of acute blood purification may improve the outcome in cases of toxic shock-like syndrome and presence of genetic high-risk haplotypes and refractory septic shock.