Adsorption in sepsis

The pathophysiology of sepsis offers a highly complicated scenario. In seps is, endotoxin or other gram-positive-derived products induce a complex and dynamic cellular response, giving rise to several mediators known to be rel evant in the pathogenesis of septic shock such as specific mediators, subst ances responsible for up- or down-regulation of cytokine receptors and cyto kine antagonists, inactivators of translational or transductional pathways, and precursor molecules. Tn this review, we delve into some new concepts s temming up from the use of sorbents in continuous plasma filtration. Nonspe cific simultaneous removal of several mediators of the inflammatory cascade have led to improved outcomes in animal models of septic shock and to impr oved hemodynamics in a pilot clinical study. It seems of great importance t o explore all possible treatment techniques that may have a direct impact o n circulating mediators of sepsis and that also may interfere with the imba lance between proirflammatory and anti-inflammatory substances in the criti cally ill patient with multiple organ failure. Tn this view, the applicatio n of sorbents appears to open new and interesting therapeutic options. The search for innovative treatments specifically targeted to the special needs of the critically ill patients seems therefore more important than the att empt to adjust concepts and technologies that are normally applied to patie nts with chronic renal failure.