Extracorporeal Blood Purification for Immunomodulatory or Hybrid Support in Sepsis

Sepsis is a dysregulated host response to a pathogen, which leads to multiple organ system dysfunction and death in the intensive care unit. As the pathogenesis of sepsis is a complex net of interconnected pathways, several attempts to improve patient outcomes by immunomodulating and targeting specific factors have been unsuccessful. The ideal immunomodulatory strategy would be modulation with restoration of immunologic stability. In our opinion, immunomodulatory support therapy in sepsis should be based on nonspecific methods of modulating and influencing inflammatory response without suppression. In this setting, extracorporeal therapies that include hemodialysis, hemofiltration, hemoadsorption, plasma filtration, and combinations of any of these are excellent approaches to modulating inflammatory response. In recent years, there have been considerable advances in our understanding and technical capabilities, but a consensus over the optimal way and timing has yet to exist. Generally, these therapies have been adapted to sepsis from nephrology-based therapy (hemodialysis for renal failure) or hematology-based therapy (plasma exchange for thrombotic thrombocytopenic purpura). In the present chapter, we will discuss the several modalities of extracorporeal blood purification in sepsis.