A review of plasma exchange in sepsis

BACKGROUND: Severe sepsis involves a generalised inflammatory response, mediated by a number of cellular and humoral factors. Modulation of this response holds the promise of improved survival. Plasma exchange has been suggested as an adjunctive therapy in grave infective illnesses such as meningococcaemia, because it might remove harmful bacterial products and excessive endogenous inflammatory mediators. AIMS: The aim of this article is to outline plasma exchange as an adjunctive therapy in sepsis, with an emphasis on the available clinical and experimental evidence for its use. METHODS: A literature review was performed using Medline including all English language references to exchange transfusion, plasma exchange, plasmapheresis, plasma filtration and sepsis. Relevant texts and conference proceedings booklets were also hand searched. RESULTS: Uncontrolled human data from case reports of more than 40 patients treated with plasma exchange for severe sepsis suggest a survival rate of over 70%. Animal studies produced conflicting results depending on the species and the model of sepsis employed. The only controlled clinical trial was too small to make conclusions regarding mortality. CONCLUSIONS: Plasma exchange remains an intuitively attractive but unproven therapy in sepsis. More controlled clinical trials are needed.