Blood purification in adult patients in sepsis and septic shock

A Network Meta-Analysis (NMA) published in CCM by SCCM on july20, 2023 to review current situation of impact of blood purification modalities on survival of adult patients with sepsis and septic shock.

A total of 60 RCTs with 4595 participants were included from search in PubMed, MEDLINE, clinical trial registries, Cochrane Library, and Embase databases with no language restrictions comparing 16 modalities and 17 interventions.

 Polymyxin-B hemoperfusion (relative risk [RR]: 0.70; 95% CI, 0.57–0.86) and plasma exchange (RR: 0.61; 95% CI, 0.42–0.91) were associated with low mortality (very low and low certainty of evidence, respectively).

 Shorter ICU stay and reduction in MV days seen in HA330 with high-volume continuous venovenous hemofiltration (CVVH), HA330, and standard-volume CVVH. No decrease in the incidence of AKI or the need for kidney replacement therapy seen in any one.

 This NMA suggests that plasma exchange and polymyxin-B hemoperfusion may be benefitial for adult patients with sepsis/septic shock when compared with standard care alone. Further RCTs required for defining the group of patients that may be beneficial.

Cytosorb has moderate certainity of evidence , plasma exchange has low certainity of evidence and rests all have very low certainity of evidence.

Chen, Jia-Jin MD1; Lai, Pei-Chun MD, PhD2; Lee, Tao-Han MD3; Huang, Yen-Ta MD, MSc, PhD4. Blood Purification for Adult Patients With Severe Infection or Sepsis/Septic Shock: A Network Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine ():10.1097/CCM.0000000000005991, July 20, 2023. | DOI: 10.1097/CCM.0000000000005991