Endotoxin adsorption or hemodiafiltration in the treatment of multiple organ failure

Abstract

Recently, blood purification has come to be considered as a useful modality for the removal of humoral mediators of sepsis and septic multiple organ failure. An endotoxin-adsorbing column and continuous hemofiltration (CHF) or continuous hemodiafiltration (CHDF) are most frequently applied for this purpose. However, as for the endotoxin-adsorbing column, indications seem to be limited, since the number of patients in whom endotoxin plays an important role is relatively small. Furthermore, the endotoxin-adsorbing column itself should be improved to achieve better removing capacity. As for CHF and CHDF, their removal capacity for cytokine is dependent on the membrane material, because adsorption of cytokines to the membrane is an important mechanism of cytokine removal. Clearance of cytokine with CHF or CHDF also depends on the pretreatment blood level of cytokines. Therefore, CHF and CHDF can remove cytokines from circulation when proper membranes with adsorbing capacity are used and when prefiltration blood level of these cytokines is high. There has been no large-scale clinical trial reporting the efficacy of CHF or CHDF as a method for cytokine removal, however. A prospective randomized clinical trial is badly needed before these modalities can be widely used for the treatment of sepsis.