title: [Adsorption therapy in sepsis].
abstract: BACKGROUND
  The activation of multiple pro- and anti-inflammatory mediators is a key feature in the pathophysiology of sepsis. Many of these mediators may directly contribute to organ dysfunction and determine disease severity. So far our ability to modulate these upregulated mediator pathways is very limited. Therefore the adsorption of such mediators via an extracorporeal circuit may be a beneficial intervention during sepsis.
  
  
  OBJECTIVE
  Recent technical innovations have made this intervention feasible. Both systems for exclusive mediator adsorption and for adsorption beside a conventional renal replacement therapy are now available. Some of the membranes can adsorb a broad range of mediators by rather unspecific binding, whereas others specifically adsorb endotoxin or mediators.
  
  
  CONCLUSIONS
  Whilst biochemical efficacy could be demonstrated by some of the systems, controlled and randomized studies demonstrating improved clinical endpoints are still lacking. Therefore the use of such therapies outside clinical studies cannot yet be recommended.
authors.affiliation: Klinik für Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland, dietrich.hasper@charite.de.
authors.forename: D
authors.initials: D
authors.lastname: Hasper
authors.forename: J C
authors.initials: JC
authors.lastname: Schefold
authors.forename: A
authors.initials: A
authors.lastname: Jörres
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy; D000818:Animals; D003131:Combined Modality Therapy; D003422:Critical Care; D016638:Critical Illness; D004731:Endotoxins / Q000097:blood; D005240:Feasibility Studies; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods; D006464:Hemoperfusion / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008567:Membranes, Artificial; D009102:Multiple Organ Failure / Q000503:physiopathology / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000295:instrumentation / Q000379:methods; D018805:Sepsis / Q000503:physiopathology* / Q000628:therapy*; D013552:Swine; D015854:Up-Regulation / Q000502:physiology
chemical_list: D004731:Endotoxins; D018836:Inflammation Mediators; D008567:Membranes, Artificial