Extrakorporale Therapie bei Sepsis – wann steht das therapeutische Fenster offen?

Zusammenfassung

Die Sepsis ist eine der häufigsten Indikationen für die Intensivtherapie. Die überschießende pathologische Immunreaktion des Patienten und die daraus resultierenden Organdysfunktionen mit hoher Mortalität sind die zentralen pathophysiologischen Komponenten der Sepsis, die früh im Krankheitsverlauf initiiert werden. Die wenigsten septischen Patienten sterben an der Infektion per se, sondern an ihrer systemisch ablaufenden inflammatorischen Antwort auf die Pathogene und Endotoxine der Infektion mit der ausgelösten Freisetzung von Zytokinen. Der adjuvante Einsatz extrakorporaler Verfahren zur raschen Entfernung übermäßig erhöhter Toxine und Entzündungsmediatoren aus dem Blut, stellt einen pathophysiologisch plausiblen Therapieansatz dar. In den letzten Jahren bestätigten Studien das Potenzial verschiedener Methoden der extrakorporalen Blutreinigung bei Sepsis und septischem Schock. Weitere Forschungsanstrengungen sind erforderlich, um die optimalen Anwendungsstrategien zu definieren und den klinischen Nutzen robust nachzuweisen. Die Zukunft liegt in der personalisierten Nutzung dieser Technologien.

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