Plasmapheresis in sepsis

Abstract

Despite the impressive advances in our understanding of the basic mechanisms of sepsis, mortality associated with sepsis remains high. Some experimental and clinical evidence suggests that hemofiltration or other techniques commonly used in the continuous renal replacement therapies are able to remove sepsis mediators, although the precise mechanism responsible (filtration or adsorption) can differ according to the membrane used. It has not yet been convincingly demonstrated, however, that this effect can influence the outcome. In recent years, plasma processing techniques such as plasma exchange and plasmapheresis have been increasingly used with the aim of removing septic mediators. Albeit slightly more complicated than the commonly used continuous renal replacement therapy techniques, these procedures allow the removal of substances with higher molecular weight, and, with the more sophisticated devices, the plasma processed can be reinfused instead of discarded, thus reducing the need for replacement fluid. Even if these treatments have been associated with an overall improvement of sepsis-induced pathophysiologic derangements, more experience is needed to establish their effect on the outcome of septic patients.