Plasma Exchange and Sepsis: An Opportunity to Transition from “All or Nothing” Medicine to Individualized Patient Centered Care

Sepsis remains the bread and butter of critical care medicine, but despite detailed knowledge of the pathophysiology, prospective clinical trials continue to yield disappointing results and the mortality for sepsis remains unacceptably high. Current definitions and inclusion criteria from current clinical care standards make studies very unlikely to be “positive” despite the likelihood that the studied therapies may indeed be clinically efficacious. The Society of Critical Care medicine has acknowledged these limitations and has proposed a focus on individualized management of sepsis research. Therapeutic plasma exchange (TPE) has an extensive body of literature to support its role in sepsis, but the current standards of care do not often include TPE in the management algorithm. These findings highlight current flaws in research and bedside care, while offering the opportunity to apply the recommendations of the Surviving Sepsis Campaign and improved patient care- both now and in the future.