Abstract
There is currently a clear biologic rationale for blood purification used in sepsis. Immunomodulation and organ support play important roles in the application of blood purification. Conventional continuous venovenous hemofiltration and hemodialysis have been shown not to be effective in sepsis in the absence of concomitant acute renal failure. Plasma therapies, high-volume hemofiltration, hemadsorption, or combinations of these therapies appear promising. However many questions still remain unanswered. Current technologies still remain inadequate for the removal of middle-molecular-weight substances, and the current practice worldwide is extremely variable. Moreover, there is lack of large-scale randomized clinical trials. Recently, new developing technologies may enhance the clinical results of current RRT strategies, including high-porosity of membranes to improve middle molecular clearance. Finally, multicenter randomized controlled trials are needed to test these promising blood purification technologies.
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