Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls

Table 3 The commonly used adsorption cartridges and their prescriptions

	Toraymyxin	Cytosorb	Oxiris	LPS adsorber	HA 330
Composition	Polymyxin B-immobilized fiber blood-purification column	Porous polymer beads	AN69-based membrane, surface treated with PEI and grafted with heparin	Synthetic polypeptide bound to porous polyethylene discs	Styrene divinylbenzene copolymers
Indication	Severe sepsis and septic shock	Severe sepsis and septic shock Cardiac surgery with SIRS	Severe sepsis and septic shock	Severe sepsis and septic shock	Severe sepsis and septic shock
Toxins removed	Endotoxins	Cytokines/chemokines Anaphylatoxins Myoglobin Free hemoglobin Bilirubin/bile acids Toxins/metals Drugs	Endotoxin Cytokines	Endotoxins	Cytokines Complements Free hemoglobin
Prescription	2-h session daily for 2 consecutive days	Up to 24-h therapy daily for 2–7 consecutive days	Prescribed dose > 35 ml/kg/h (60% convective). Filter replacement after 24 h or if there is no reduction in VP dose by 50%. Treatment should be stopped if VP are reduced by > 50% or after 3 days of treatment in case of no-response	2–6 h. One session is usually sufficient to achieve improvement. Repeated procedures can be performed	2–6 h daily for 2 days
Blood flow rate (ml/min)	80–120	150–700	100–450	150 ± 50	100–300
Anticoagulation	Heparin	Heparin or citrate	Heparin	Heparin	Heparin or citrate
Additional features	Polymyxin B antimicrobial effect	Largest surface area	Lower risk of thrombogenicity by adsorbing antithrombin-III from the blood

CRRT continuous renal replacement therapy, LPS lipopolysaccharides, PEI polyethyleneimine, SIRS systemic inflammatory response syndrome, VP vasopressors

ISSN: 1364-8535