Usefulness of hemoperfusion carridges in septic shock.

Abstract

Introduction: Septic shock is one of the most frequent entities observed in Intensive Care Units and is associated with high morbidity and mortality. Sepsis is characterized by a dysregulation of the immune system. In it, an imbalance occurs between pro-inflammatory substances and anti-inflammatory substances. Septic patients often have an elevation in endotoxin and cytokine levels. Elevated levels of cytokines in these patients have been associated with higher mortality. Hemoperfusion or hemoadsorption is a blood purification technique whose objective is to decrease the levels of cytokines in plasma. There are three devices on the market: the cytosorb, the polymyxin B, and the Oxiris cartridge. Discussion: With regard to cytosorb, there is no evidence that makes us advise the use of cytosorb routinely in patients with septic shock. Regarding polymyxin B, there is insufficient evidence available in the literature to advise the use of these cartridges in patients with septic shock on a routine basis. Finally, with the Oxiris cartridge there are no studies whose primary objective is the analysis of mortality, so its use cannot be recommended routinely. Conclusions: There is no conclusive evidence on which to base to advise the use of absorption therapies in patients in septic shock. There is only a subpopulation of patients with severe septic shock and high mortality (based on severity scales) in which these types of therapies may show certain benefits.