A dysregulated immune response is associated with an excessive release of cytokines
that can lead to systemic vasoplegia and vasoplegic shock with the development of
multiorgan failure that is associated with an increased risk of dying. Under physiological
circumstances, the endothelium and the glycocalyx are responsible for maintaining
vascular tone, capillary permeability, and hemostasis, and controlling inflammation.
In hyperinflammation, the endothelium and glycocalyx become damaged due to the excessive
production of certain toxic proteins, along with an overwhelming release of cytokines.
It has been shown in both in vitro animal experiments and in humans that extracorporeal
hemoadsorption can reduce circulating levels of cytokines and may also remove toxic
proteins that directly take part in endothelium and glycocalyx damage. The current
review aims to summarize current knowledge, put recent findings into context, and
introduce the hypothesis of "endothelial protection with hemoadsorption" in critically
ill patients.
