Bridge over troubled water or road to nowhere? Adsorptive procedures in critically ill patients on the intensive care unit

Of the ca. 150,000 patients per year affected by sepsis in Germany less than half survive. As there is no specific pharmacological intervention for sepsis (except for anti-infective agents), various forms of extracorporeal treatment are currently employed, which cannot be arbitrarily interchanged. The elimination of pathogens and reduction of cytokines or specific mediators can all be grouped under the term hemoperfusion, which for many is still a synonym for active charcoal adsorber, which 50 years ago was the most frequently used extracorporeal treatment for poisoning. In the last 10-15 years this treatment gave way to biocompatible materials, which bind different substances depending on the properties. Although hemoperfusion can be performed as a stand-alone treatment it is more frequently used in combination with other extracorporeal forms of treatment, such as kidney replacement therapy (KRT) or extracorporeal membrane oxygenation (ECMO). This means that the initiation of hemoperfusion is often delayed until after organ failure has occurred. Whether this is too late, remains unclear. This overview article summarizes the pathophysiological background, the technical concepts and the available clinical data for the different hemoperfusion procedures.