Blood purification for septic multiple organ failure

Abstract

It has been reported that removal of overproduced mediators using blood purification is an effective method to prevent and treat septic multiple organ failure. Although the mediators can be removed by any of filtration, dialysis, or adsorption when the blood purification is performed in appropriate settings, high-volume hemofiltration (HVHF) has not improved outcomes in large multicenter randomized control trials (RCTs). Because massive loss of essential substances such as antibiotics or nutrients is considered to be one of the reasons for this negative result, dialysis with high cut-off membrane will repeat the folly of HVHF. Blood purification using a cytokine adsorbing hemofilter (polymethylmethacrylate, AN69ST, and oXiris^®) has demonstrated a promising level of efficacy in some recent case series. Therefore, it will be necessary to prove its efficacy in RCTs in the future. In these RCTs, it will be important to enroll patients in critical condition as demonstrated by blood levels of cytokines or severity scores such as the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score to validate the efficacy of cytokine adsorbing hemofilters.