Adjunctive multimodal extracorporeal support in severe septic shock with multi-organ failure: a case report

Septic shock is a life-threatening condition that frequently progresses to multi-organ dysfunction despite optimal standard-of-care therapies. Extracorporeal blood purification (EBP) techniques have gained attention as adjunctive strategies aimed at modulating hyperinflammation and supporting failing organs. We describe the case of a 64-year-old woman with septic shock, likely secondary to urosepsis, complicated by acute respiratory failure, acute kidney injury, acute liver failure, and cytopenias. Initial management with fluid resuscitation, empirical broad-spectrum antibiotics, corticosteroids, and non-invasive ventilation proved insufficient. Given profound hyperinflammation (IL-6: 47,089 pg./mL) and severe metabolic derangements, continuous veno-venous hemodiafiltration (CVVHDF) with hemoadsorption was initiated, resulting in rapid IL-6 reduction and hemodynamic stabilization. As her clinical course evolved, a multimodal EBP approach, including sequential hemoadsorption devices, therapeutic plasma exchange, and the double plasma molecular adsorption system (DPMAS), was employed to support renal and hepatic function, at one point requiring two separate extracorporeal circuits operating concurrently for different EBP modalities. Progressive respiratory failure necessitated invasive mechanical ventilation, prone positioning, and subsequent tracheostomy. The patient ultimately recovered, with restoration of hepatic and renal function, resolution of cytopenias, and successful weaning from mechanical ventilation. This case underscores the potential role of adjunctive multimodal EBP in refractory septic shock with severe multi-organ failure. Although clinical improvement paralleled biomarker reduction, causal inference is limited by the concurrent use of multiple therapies. Robust randomized studies are needed to clarify optimal protocols, timing, and patient selection for combined extracorporeal strategies in critical sepsis.