Septic shock is the main cause of death in the intensive care unit. Extracorporeal blood purification therapies are now being proposed in order to improve septic shock outcomes. These therapies work based on immunomodulation of the host inflammatory response, obtained by non selectively removing inflammatory mediators. We report data from several different studies performed in vitro, in animals and in human beings, assessing various blood purification therapies which include high-volume hemofiltration, cascade hemofiltration, high-adsorption hemofiltration, coupled plasma filtration adsorption, hemoadsorption and high-permeability hemodialysis. This translational research work shows that blood purification therapies are capable of removing not only the inflammatory mediators but also the endotoxins as far as highadsorptionhemofiltration and hemoadsorption are concerned. We demonstrate technical feasibility, safety and advantages of cascade hemofiltration and continuous high-permeability hemodialysis. The beneficial hemodynamic effects related to these blood purification techniques are also highlighted. For future research, optimization of the most efficient techniques is warranted, takinginto account of their respective advantages and drawbacks. Regarding pathophysiology, the direct effect of these therapies on leukocyte function is subject to further investigation. To date, convection, diffusion and adsorption should not be viewed in opposition but rather, seen as complementary mechanisms.
