Background/Objectives: Sepsis, a life-threatening condition caused by a dysregulated immune response to infection, is associated with high mortality. Endotoxin and cytokine overload play a crucial role in sepsis-induced organ dysfunction. The Oxiris^® membrane, traditionally used as a hemofilter for renal replacement therapy, has demonstrated the capacity to adsorb endotoxins and cytokines. This study investigates the clinical effect during hemoperfusion with the Oxiris^® membrane in patients with septic shock and preserved renal function. Methods: We present three adult patients with septic shock who were admitted to the intensive care unit with high vasopressor requirements and elevated inflammatory markers. As they were refractory to standard therapy and renal function was preserved, a 12-hour hemoperfusion session with an Oxiris^® membrane was initiated. Hemodynamic parameters, inflammatory biomarkers, and endotoxin concentrations were evaluated before, during, and after hemoperfusion treatment. Results: All patients demonstrated hemodynamic stabilization, with norepinephrine support reduced by 10.3% to 70.0%. Key inflammatory markers decreased significantly, including interleukin-6 (−41.6% to −94.0%), procalcitonin (−29.3% to −49.5%), and C-reactive protein (4.7% to −37.2%). Endotoxin concentrations decreased by 62.0% and 13.6% in two of the three patients. No adverse effects related to hemoperfusion were observed. Conclusions: Hemoperfusion with the Oxiris^® membrane effectively reduced vasopressor support, inflammatory markers, and endotoxin concentrations in patients with refractory septic shock. This approach may offer a novel strategy for early immune modulation in sepsis before renal dysfunction occurs. Further studies with larger cohorts are required to validate these findings and determine optimal treatment protocols.

Background and Objectives: Sepsis, a leading global health challenge, accounts for around 20% of deaths worldwide. The complexity of sepsis, especially the difference between bacterial and viral etiologies, requires an effective assessment of microcirculation during resuscitation. This study aimed to evaluate the impact of infusion therapy on microcirculation in patients with sepsis, focusing on bacterial- and COVID-19-associated sepsis using remote photoplethysmography (rPPG) and the automated capillary refill time (aCRT). Materials and Methods: This single-center prospective study was conducted in the ICU of Pauls Stradins Clinical University Hospital, including 20 patients with sepsis/septic shock. The patients were selected based on hemodynamic instability and divided into COVID-19 and Bacterial Septic Shock groups. Fluid responsiveness was assessed using the Passive Leg Raising Test (PLRT). Systemic hemodynamics and microcirculation were monitored through MAP CRT, rPPG, and serum lactate levels. Statistical analyses compared responses within and between the groups across different stages of the protocol. Results: The Bacterial group exhibited higher initial serum lactate levels and more pronounced microcirculatory dysfunction than the COVID-19 group. rPPG was more sensitive in detecting perfusion changes, showing significant differences between the groups. The automated CRT demonstrated greater sensitivity compared to the manual CRT, revealing significant differences during PLRT stages between bacterial- and COVID-19-associated sepsis. Both groups had a transient hemodynamic response to PLRT, with subsequent stabilization upon fluid infusion. Conclusions: When managing patients with sepsis in intensive care, monitoring microcirculation is of paramount importance in infusion therapy. Our study highlights the potential of rPPG and aCRT as tools for this purpose. These techniques can be used in conjunction with routine parameters, such as lactate levels and systemic hemodynamic parameters, to provide a comprehensive assessment of a patient’s condition.

Background and Objectives: Sepsis, a life-threatening condition caused by a dysregulated immune response to infection, is associated with high mortality. Endotoxin and cytokine overload play a crucial role in sepsis-induced organ dysfunction. The Oxiris® membrane, traditionally used as a hemofilter for renal replacement therapy, has demonstrated the capacity to adsorb endotoxins and cytokines. This study investigates the clinical effect during hemoperfusion with the Oxiris® membrane in patients with septic shock and preserved renal function. Materials and Methods: We present three adult patients with septic shock who were admitted to the intensive care unit with high vasopressor requirements and elevated inflammatory markers. As they were refractory to standard therapy and renal function was preserved, a 12-hour hemoperfusion session with Oxiris® membrane was initiated. Hemodynamic parameters, inflammatory biomarkers, and endotoxin concentrations were evaluated before, during and after hemoperfusion treatment. Results: All patients demonstrated hemodynamic stabilization, with norepinephrine support reduced by 10.3% to 70.0%. Key inflammatory markers decreased significantly, including interleukin-6 (-41.6% to -94.0%), procalcitonin (-29.3% to -49.5%), C-reactive protein (4.7% to -37.2%). Endotoxin concentrations decreased by 62.0% and 13.6% in two of the three patients. No adverse effects related to hemoperfusion were observed. Conclusions: Hemoperfusion with the Oxiris® membrane effectively reduced vasopressor support, inflammatory markers, and endotoxin concentrations in patients with refractory septic shock. This approach may offer a novel strategy for early immune modulation in sepsis before renal dysfunction occurs. Further studies with larger cohorts are required to validate these findings and determine optimal treatment protocols.

The indications for extracorporeal membrane oxygenation (ECMO) are becoming increasingly widespread nowadays. This case report describes the unique presentation of an adult patient with a combination of two rare complications: life-threatening angioedema caused by angiotensin-converting enzyme inhibitors (ACEi) and subsequent post-obstructive negative pressure pulmonary edema (NPPE). In this case, worsening angioedema that was unresponsive to medication led to severe airway obstruction and near-fatal acute respiratory syndrome due to NPPE. The worsening clinical course required a multidisciplinary approach and immediate initiation of extracorporeal membrane oxygenation (VV-ECMO). The literature reports that most NPPE cases resolve with oxygenation. However, in our case, the NPPE was refractory to mechanical ventilatory support, and we had to initiate VV-ECMO to prevent the patient from going into cardiac arrest due to severe hypoxia. This case underscores the critical role of VV-ECMO as a bridge to recovery from severe NPPE. It also highlights the need to raise clinicians’ awareness of the potential life-threatening side effects of the commonly used antihypertensive drug perindopril.

Background: Microcirculatory dysfunction is a key feature of septic shock and contributes to organ failure despite the apparent normalization of systemic hemodynamic parameters. Extracorporeal blood purification (EBP) therapies aim to modulate the dysregulated inflammatory response through removal of endotoxins and cytokines; however, their impact on tissue-level perfusion remains unclear. Direct bedside assessment of microcirculation may provide mechanistic insight into the effects of EBP beyond macrohemodynamic stabilization. Methods: This structured narrative review summarizes current evidence on direct microcirculatory assessment during EBP therapy in sepsis. A literature search of PubMed, Web of Science, and Scopus was performed using combinations of the terms “microcirculation” and “blood purification” or “hemoadsorption.” Studies published between 2015 and 2026 evaluating direct sublingual microcirculation using sidestream dark field (SDF) or incident dark field (IDF) videomicroscopy during EBP were included. Both experimental and clinical studies were considered. Results: Eight studies met the inclusion criteria. Selective endotoxin adsorption with polymyxin B hemoperfusion (PMX-HP) demonstrated improvements in perfused vessel density and small vessel density in both animal and clinical settings. Non-selective cytokine adsorption devices (CytoSorb and HA380) were associated with increases in microvascular flow index (MFI), perfused vessel density (PVD), and proportion of perfused vessels (PPV), although most data derive from small observational studies. Across studies, improvements in microcirculatory parameters were observed during or following hemoadsorption therapy; however, heterogeneity in design, timing, and concomitant treatments limits definitive interpretation. Conclusions: Current evidence suggests that EBP may positively influence microvascular perfusion in septic shock when assessed using direct videomicroscopy. Nevertheless, data remain limited and predominantly observational. Larger randomized controlled trials incorporating predefined microcirculatory endpoints are required to determine whether mediator removal translates into sustained restoration of tissue perfusion and improved clinical outcomes.

Introduction: Extracorporeal blood purification is increasingly used as adjunctive therapy in septic shock to modulate dysregulated host immune responses. The AN69-polyethyleneimine-based Oxiris hemofilter combines renal replacement therapy with nonselective adsorption of endotoxin and inflammatory mediators. Despite its widespread clinical use and reported biological and hemodynamic effects, the in vivo adsorption capacity, saturation kinetics, and duration of effective solute removal during routine clinical application remain insufficiently characterized. Methods: This is a prospective, single-center observational cohort study enrolling 29 adult patients with septic shock and sepsis-associated acute kidney injury undergoing continuous veno-venous hemofiltration with the Oxiris hemofilter as part of standard care. Both blood samples (from the inlet and outlet of the extracorporeal circuit) and effluent samples will be collected at predefined time points within the first 24 h of treatment. Endotoxin concentrations will be measured using a high-sensitivity competitive enzyme-linked immunosorbent assay, and inflammatory mediators will be quantified using multiplex immunoassays. The primary analysis will evaluate the dynamic adsorption capacity and saturation behavior of the Oxiris membrane for endotoxin and inflammatory mediators by analyzing the relationship between inlet concentrations and adsorption rates over time using Pearson correlation coefficients with Fisher’s Z-transformation. Secondary outcomes include changes in hemodynamics, lactate, inflammatory biomarkers, renal recovery, intensive care unit length of stay, and 28-day mortality. Conclusion: This study aimed to provide systematic in vivo characterization of adsorption kinetics, clearance mechanisms, and saturation dynamics of the Oxiris hemofilter in septic shock. The findings are expected to support more rational filter replacement strategies and individualized treatment timing, thereby enabling a more targeted and evidence-based application of the Oxiris therapy in critically ill patients.