This Narrative Review is the outcome of the round table held during the Workshop of Purification Therapies 2022, where renowned experts examined critical aspects of implementing extracorporeal therapies in septic patients. The discussion focused on improving patient selection criteria, optimizing treatment strategies, and exploring innovative research methodologies. These topics will serve as the starting point for further discussions at the Workshop of Purification Therapies 2025, making this Narrative Review a bridge between the two events.

In the introduction, the authors highlight that sepsis pathogenesis involves a dysregulated response to both pro- and anti-inflammatory stimuli, with each patient following a unique trajectory. Among the various therapeutic strategies, available to clinicians for controlling this dysregulated inflammatory response, are adjunctive therapies, including extracorporeal therapies.

The rationale for using extracorporeal therapies (RRT – Renal Replacement Therapy, TPE – Therapeutic plasma exchange, CPFA – Continuous Plasma Filtration Adsorption), with a particular focus on the more recent hemoadsorption technique, lies in their ability to: modulate cytokines and other inflammatory mediators, improve hemodynamics, reduce organ support needs, and positively impact the microcirculation. This outcome has been demonstrated in studies strengthened by statistical matching techniques (e.g., propensity score). However, conflicting results often stem from significant confounding factors in population selection, with more severe patients included in intervention groups, leading to unbalanced cohorts. Consequently, meta-analyses based on such studies have produced results that are difficult to interpret and apply in clinical practice.

To optimize the use of extracorporeal therapies, the authors emphasize that the future of hemoadsorption lies in shifting from large-scale randomized trials to personalized, adaptive studies tailored to specific, objective patient criteria. The primary outcomes in these studies should focus not on mortality but on morbidity endpoints.

So, what should be done in clinical practice? The most appropriate therapy should be guided by hemodynamic and metabolic parameters, including inotrope dosage, VIS score, mean arterial pressure (MAP), lactate levels, pH, microcirculation, mechanical ventilation needs, ICU length of stay, chronic kidney disease prevention, and quality of life. Additionally, the concurrent administration of antibiotics requires careful dosage adjustments when combined with extracorporeal blood purification therapies (which should not be avoided for this reason).

In conclusion, the authors remind that the era of the “one-size-fits-all” approach to sepsis treatment is over. It is time for a paradigm shift toward more targeted approaches, both in clinical practice and research, where each patient is carefully evaluated and treated promptly and for the duration necessary according to their individual pathophysiological profile.

In the 4th edition of the Workshop, speakers will further explore these themes and delve into innovative strategies for sepsis care, reaffirming that each patient’s journey is unique.

Read the open-access Narrative Review https://bit.ly/3EIANHu

Contribute to the conversation by submitting your abstract to purification.therapies@aferetica.com

WPT 2025 Call for Abstracts Deadline: Friday, June 13th, 2025

Discover submission guidelines here https://www.purificationtherapies.com/wpt-2025/call-for-abstract/

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