Use of adsorptive mechanisms in continuous renal replacement therapies in the critically ill

The pathophysiology of sepsis is becoming a more complicated scenario. In s epsis, endotoxin or other gram-positive derived products induce a complex a nd dynamic cellular response giving rise to several mediators known to be r elevant in the pathogenesis of septic shock, such as specific mediators, su bstances responsible for up- or downregulation of cytokine receptors and cy tokine antagonists, inactivators of nuclear factor-KB or signal transductio n pathways, and precursor molecules. In this article, we delve into some ne w concepts stemming from the use of sorbents in continuous plasma filtratio n. The rationale is based on the assumption that the nonspecific removal of several mediators of the inflammatory cascade and cytokine network may imp rove outcome in a rabbit model of septic shock and hemodynamics in a pilot clinical study. The importance of looking for innovative treatments specifi cally targeted for the special needs of the critically ill patients rather than using concepts and technology applied to the treatment of chronic rena l failure is underlined.