Cytokine removal in human septic shock: Where are we and where are we going?

Cytokine response after sepsis. Normal and abnormal immune response after an (infectious) insult (A). Recovery with regaining of the homeostatic balance occurs when pro-inflammatory (solid red line) and anti-inflammatory (solid blue line) mediators (B) return back to baseline levels. Early death or fulminant septic shock (C) can occur following early increased innate pro-inflammatory response (cytokine storm, dotted red line) or after initial adaptive immunosuppression (dashed blue line). Immunoparalysis (D) can occur following early increased adaptive anti-inflammatory response (immunosuppression, dotted blue line) or after initial pro-inflammatory response (dashed red line). Haemoadsorption with Cytosorb？ may attenuate the initial pro- (bold red line) and anti-inflammatory (bold blue line) response resulting in early recovery (E