Sepsis is the result of a dysregulated immune response to infection and is associated with acute organdysfunction. The syndrome’s complexity is contingent upon the underlying pathology and individual patient char‑acteristics, including their immune response. The involvement of multiple organs and physiological functions addscomplexity, with “organ cross‑talk” emerging as a pivotal pathophysiological and clinical aspect. This narrative reviewto evaluate the rationale and available clinical evidence supporting the use of extracorporeal blood purification thera‑pies as adjunctive therapy in patients with sepsis and septic shock.

 

A search of the PubMed, Embase, Web of Science and Scopus databases for relevant literaturefrom August 2002 to May 2024 has been conducted. The search was performed using the terms: 1) “blood purifica‑tion” or “hemadsorption” or “plasma exchange” AND 2) “sepsis” or “septic shock”. Therefore the authors have focusedour discussion on several key areas such as conducting well‑designed trials, developing more personalized protocols,ensuring optimal management and monitoring.

 

Given the heterogeneity of patients with sepsis, conducting traditional randomized clinical trials in thisdomain can be a daunting task. However, statistical techniques such as Bayesian methods, propensity score analysis,and emulated clinical trials using clinical databases hold promise for enhancing comparability between the studygroups. Indeed, to comprehend the clinical efficacy of extracorporeal blood purification techniques in patientswith sepsis, it is imperative to assemble homogeneous groups of patients receiving uniform treatments. Clinicalstrategies should be individualized, signaling the end of the “one size fits all” approach in sepsis therapy and the needfor personalized treatments.