To remove and replace—a role for plasma exchange in counterbalancing the host response in sepsis

Excerpt

Septic patients do not usually die from their infection per se but rather from an overwhelming pathological host response to it. Given that treatment is limited to resuscitation strategies, anti-infectives, and source control [1], it is of no surprise that innovative approaches that modify the overwhelming systemic reaction are highly desirable. Novel adsorption techniques have recently attracted much attention and might represent a promising avenue for further investigation [2]. In this issue of Critical Care Ankawi and coworkers nicely summarized the potpourri of extracorporeal techniques in septic patients ranging from (ultra) high-volume hemofiltration to modern adsorption devices and a combination of them [3]. We enjoyed reading this article and the authors are to be congratulated for their thoughtful work, in particular with regard to the balanced nature focusing not just on promises but also on pitfalls of these methods. However, given the comprehensive presentation we were surprised that a nephrologist’s old friend—which might have an underappreciated role in extracorporeal modulation of the pathological host response—seemed to be forgotten, i.e., therapeutic plasmaexchange (TPE). …