• Rafidah Atan, David Crosbie, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Heidelberg, Vic., Australia.
• Blood Purif. 2012 Jan 1;33(1-3):88-100.

Background And AimsAttempts at achieving cytokine homeostasis include blood purification to deliver cytokine removal. Assessment of ex vivo studies for optimal operating conditions is a vital step.MethodsWe 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.ResultsWe 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.ConclusionEx 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.Copyright © 2012 S. Karger AG, Basel.

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