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Background <p>Sepsis is characterized by a&#xa0;dysregulated host response to infection and remains associated with substantial mortality. Extracorporeal blood purification strategies are explored as adjunctive approaches to modulate host–response dysregulation.</p> Objectives <p>Practice-oriented overview of current extracorporeal immunomodulatory strategies in sepsis and septic shock and a&#xa0;summary of available evidence and guideline position.</p> Materials and methods <p>Narrative review focusing on randomized trials, meta-analyses, guidelines, and ongoing study programs addressing nonselective hemoadsorption, selective endotoxin removal, and therapeutic plasma exchange.</p> Results <p>Evidence for nonselective hemoadsorption remains conflicting; recent higher-quality studies and guidelines do not show a&#xa0;proven clinical benefit and raise potential safety concerns. Selective endotoxin adsorption is biologically plausible and may be relevant in endotoxin-positive subgroups. Therapeutic plasma exchange is supported by mechanistic rationale, small randomized studies, and meta-analyses; confirmation in adequately powered multicenter trials is pending.</p> Conclusion <p>Extracorporeal immunomodulation should not be regarded as a&#xa0;uniform intervention. Progress will depend on precise patient selection, biomarker-guided allocation, appropriate dosing, and structured implementation. Until robust outcome data are available, these therapies should be used cautiously and preferably in experienced centers or study frameworks.</p>

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Extrakorporale Immunmodulation in der Sepsis

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Thorben Pape,
  • Roman Förster,
  • Timm Daron,
  • Benjamin Seeliger,
  • Sascha David,
  • Klaus Stahl

摘要

Background

Sepsis is characterized by a dysregulated host response to infection and remains associated with substantial mortality. Extracorporeal blood purification strategies are explored as adjunctive approaches to modulate host–response dysregulation.

Objectives

Practice-oriented overview of current extracorporeal immunomodulatory strategies in sepsis and septic shock and a summary of available evidence and guideline position.

Materials and methods

Narrative review focusing on randomized trials, meta-analyses, guidelines, and ongoing study programs addressing nonselective hemoadsorption, selective endotoxin removal, and therapeutic plasma exchange.

Results

Evidence for nonselective hemoadsorption remains conflicting; recent higher-quality studies and guidelines do not show a proven clinical benefit and raise potential safety concerns. Selective endotoxin adsorption is biologically plausible and may be relevant in endotoxin-positive subgroups. Therapeutic plasma exchange is supported by mechanistic rationale, small randomized studies, and meta-analyses; confirmation in adequately powered multicenter trials is pending.

Conclusion

Extracorporeal immunomodulation should not be regarded as a uniform intervention. Progress will depend on precise patient selection, biomarker-guided allocation, appropriate dosing, and structured implementation. Until robust outcome data are available, these therapies should be used cautiously and preferably in experienced centers or study frameworks.