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Titolo Techniques of Extracorporeal Cytokine Removal: A Systematic Review of the Literature
Autore Rafidah Atan b David Crosbie a Rinaldo Bellomo a - a Department of Intensive Care, Austin Hospital, Heidelberg, Vic. , Australia; b Johor Bahru Clinical School, Monash University Sunway Campus, Johor Bahru, Malaysia
Referenza Blood Purif 2012; 33: 88-100

Background and Aims: Attempts at
achieving cytokine homeostasis include blood purification to deliver cytokine
removal. Assessment of ex vivo studies for optimal operating conditions is a
vital step.

Methods: We conducted
a systematic search for ex vivo studies on cytokine removal using known
modalities of extracorporeal circulation. We selected 29 articles and analyzed
data according to clearance, sieving coefficient, ultrafiltrate concentration
and percentage removal.

Results: We
identified four main techniques for cytokine removal: standard techniques, high
cut-off (HCO) techniques, adsorption techniques and combined plasma filtration adsorption.
HCO hemofiltration (HCO/HF) showed greatest consistency in cytokine removal
among all approaches. Mean albumin clearance with HCO filters was 3.74 ml/min.

Conclusion: Ex vivo data
support the view that HCO/HF is the most consistently effective approach in
terms of sieving and clearance. Further investigation of HCO/HF in randomized
controlled trials in animal models and humans seems desirable.

Data 27.01.2012
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