Proinflammatory and antiinflammatory cytokines are filtered with plasmapheresis and continuous renal replacement therapy. Therapeutic apheresis is capable of restoring the normal mechanism for programmed white blood cell death. The potential to make a broad-brush assault on the unregulated pathologic systemic inflammatory response may prove to be a significant development in critical care medicine. A streptococcus toxic shock-like syndrome is encouraging. In addition to removing the mediators of inflammation, therapeutic apheresis has the capacity to eliminate directly the exotoxins and virulence factors produced by these bacteria.
Therapeutic apheresis is thus a new facet of the care of the critically ill.
In effect, it restores a proper balance between the various components of the patient's circulation. In specific patients the techniques may prove to be lifesaving. For other patients, therapeutic apheresis, like mechanical ventilation, may help the patient survive long enough for other interventions to produce a cure. Some applications, such as the treatment of organ rejection, are already practical. Other promising applications in the treatment of MOF are in a precocious infancy.