ReviewIntensive care medicine experimental2025
Knowledge gaps in extracorporeal blood purification: what would be required for its successful application in septic shock?
Review in Intensive care medicine experimental, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Intraoperative hemoadsorption and cardiac surgery-associated acute kidney injury: an updated systematic review and meta-analysis with trial sequential analysis.Critical care (London, England) · 2026Pooled it
- [Extracorporeal immunomodulation in sepsis : Role, limits, and perspectives of adjuvant blood purification therapies].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026Review
- Observational
- Sample size assumptions, timing asymmetries, and endpoint selection limit the interpretability of the CLEANSE hemoadsorption trial in septic shock.Critical care (London, England) · 2026Article
- The role of hemoadsorption in septic shock: toward a personalized approach.Critical care (London, England) · 2026Review
- Hematological parameter dynamics in critically ill patients treated with oXirisBMC nephrology · 2026Observational
- Clinical practice in using corticosteroids and adjunctive sepsis therapies at the bedside among European ICUs: an ESICM-endorsed survey.Intensive care medicine experimental · 2026Article
- Effect of therapeutic plasma exchange on acquired hypocholesterolemia in patients with septic shock: a post hoc analysis of the two exchange trials.Critical care (London, England) · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Sepsis remains a leading cause of death worldwide, characterized by a dysregulated host response to infection that results in organ dysfunction. Extracorporeal blood purification (EBP) therapies traditionally aim to remove circulating mediators involved in this pathological response, although novel technologies that can remove cells and even living pathogens have recently been developed. Despite their growing clinical use, robust evidence supporting EBP in septic shock as an adjuvant therapy is lacking, and several knowledge gaps hinder their effective and safe application. This narrative review critically examines these gaps from both mechanistic and clinical perspectives. Key issues include the dynamic and compartmentalized nature of the immune response, the unclear roles of specific cytokines, and the potential removal of protective anti-inflammatory mediators. Broad-spectrum adsorption may induce unintended immunomodulatory effects, including desorption and altered leukocyte trafficking. Selective approaches, such as endotoxin removal with polymyxin B hemoadsorption, face challenges related to dose, patient stratification, and the limitations of endotoxin activity assays. Therapeutic plasma exchange offers the potential to restore homeostasis but raises questions regarding optimal regimens, replacement fluids, and the risk of unintended drug clearance. The heterogeneity of trial designs, insufficient patient phenotyping, and variability in treatment protocols have led to inconclusive or conflicting clinical outcomes, including some trials suggesting potential harm. This review underscores the need for better mechanistic understanding, real-time immune monitoring, and ideally targeted clinical trial designs to define which patients might benefit from EBP and when. Ultimately, the path to effective application of EBP in sepsis lies in individualized therapy guided by immune profiling, biomarker-driven stratification, and rigorous evaluation in high-quality randomized controlled trials.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.