Extracorporeal
therapies are able to sustain life through different mechanisms. This approach, called multiple organ support
therapy, can in fact obtain blood purification by
hemodialysis/
hemofiltration to replace kidney function, temperature control,
electrolyte and
acid-base control to mimic homeostatic regulation of the kidney and circulation, fluid balance control to support the right hydration and cardiac performance, cardiac support removing cardiodepressant substances and equilibrating
potassium levels, blood detoxification and liver support by coupled plasma filtration and adsorption or direct adsorption on blood (
hemoperfusion),
immunomodulation and endothelial support in the presence of
sepsis by cutting the peaks of pro- and anti-inflammatory mediators, and immunoadsorption or adsorption of specific substances such as
endotoxin. A missing piece of this group of
therapies was the protective lung support. Today this is made possible by removal of CO(2) either by complete
extracorporeal membrane oxygenation or by using decapneization in conjunction with
hemofiltration in a system called DECAP/DECAPSMART. In conclusion, circulating blood outside the body and treating it with different filters or cartridges in a multiple organ support
therapy may represent an important support for multiple organ dysfunction conditions induced by
sepsis,
acute respiratory distress syndrome and in recent times by complicated H1N1-related
infections.