Fluid balance is crucial in managing septic shock. The goal of fluid therapy is to compensate for fluid loss due to capillary leakage and vasodilation; however, excessive fluid administration can worsen the patient’s recovery and prognosis. Balancing fluid replacement while avoiding excessive fluid administration is a delicate task and presents a significant challenge to patient care.

In sepsis, high levels of inflammatory mediators in the blood are associated with increasing vascular permeability and endothelial dysfunction, contributing to intravascular fluid loss. In vitro studies have confirmed that removing some of these mediators could be highly beneficial for endothelial integrity in patients with sepsis. Hemoadsorption with CytoSorb, by reducing the levels of potentially harmful inflammatory molecules in the blood, may actively help to protect the endothelium and reduce the requirement for fluid and vasopressors. One recently published study provided compelling clinical data in support of this hypothesis.

Kogelmann et al. conducted a retrospective multi-centre analysis to gauge the impact of CytoSorb use on fluid balance in patients treated for septic shock. In this study, 124 septic shock patients were treated with continuous renal replacement therapy (CRRT). The CRRT was supplemented with CytoSorb hemoadsorption and patients were assessed over a 72-hour period. The authors found that for the entire patient group, the change in fluid balance from baseline decreased significantly by the 72-hour mark. This reduction in fluid balance coincided with a decrease in catecholamine requirements, indicating that the improved fluid balance was not a consequence of increased vasopressor administration. The fluid volume requirement at 72 hours was also significantly lower in survivors than in the non-survivors, highlighting the importance of fluid balance in the context of patient outcomes.

The smaller volume required to maintain fluid balance suggests that CytoSorb therapy may help limit capillary leakage and reduce vascular permeability; a finding which could significantly impact the treatment and recovery of patients. Further, previous investigations have noted that CytoSorb therapy may also play a crucial role in stabilizing endothelial integrity. By safeguarding vascular barrier function, CytoSorb treatment would represent a potentially groundbreaking advancement in sepsis management, beyond symptomatic fluid replacement. This novel systematic investigation of the association of hemoadsorption and fluid balance sheds light on the potentially multifaceted benefits of this treatment in septic shock patients, offering important insights that could prove vital in optimizing patient care. Incorporating CytoSorb therapy into existing treatment plans could help physicians regain control of dangerous fluid imbalances and promote vascular recovery, helping patients with this critical condition get better, faster.