Septic shock & blood purification

In septic shock the host response to infection produces a surge of bacterial toxins and inflammatory mediators. Endotoxin released from Gram-negative bacteria, together with cytokines such as IL-6 and TNF-alpha, contributes to vasodilation, capillary leak, myocardial depression and progressive multi-organ failure.

Standard care targets the infection and supports the failing organs, but it does not remove the mediators themselves. Where shock is refractory and vasopressor requirements continue to escalate, clinicians increasingly consider mediator removal as an adjunct within the first hours of deterioration.

Blood is circulated through a cartridge packed with a sorbent whose surface chemistry binds target molecules as blood passes through it. Multimodal sorbents are designed to adsorb both endotoxin and a broad range of cytokines in a single pass, and the cartridge can be run standalone with a blood pump or integrated into an existing CRRT or ECMO circuit.

Therapy is time-critical and dose-dependent: earlier initiation, adequate blood flow and completing the intended treatment sessions all influence the haemodynamic response. The measurable endpoints teams typically follow are vasopressor dose, lactate clearance and mean arterial pressure.

Children are not small adults for this therapy. Extracorporeal volume, blood flow limits and cartridge priming all have to be matched to patient size, which is why a dedicated paediatric device exists rather than a scaled-down adult protocol.