{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:38:23Z","timestamp":1789141103466,"version":"build-2803163510"},"reference-count":152,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Inflammation, a complex biological response against injury or infection, is an important pathological basis for various critical diseases. A \u201cnormal\u201d immune response exemplifies a balanced dialogue between immunological cells and a medley of pro- and anti-inflammatory mediators. However, under pathological conditions, this equilibrium is disrupted by the overwhelming release of cytokines, also known as a cytokine storm, which significantly contributes to multiple organ dysfunction and death. Accumulating clinical evidence highlights the efficacy of CytoSorb\u00ae hemoadsorption in eliminating damage-associated molecular patterns, pathogen-associated molecular patterns and excessive cytokines from the blood, which underscores the broad use of CytoSorb\u00ae in managing various critical conditions. In this narrative review, we conduct a state-of-the-art review of CytoSorb\u00ae hemoadsorption in daily critical care practice. By searching \u2018CytoSorb\u00ae\u2019, \u2018cytokine absorption\u2019, \u2018hemoadsorption\u2019 and \u2018hemoperfusion\u2019 in PubMed, Embase and Web of Science, we discussed the rationale and research progress for cytokine adsorption with CytoSorb\u00ae from January 2019 to May 2025. Then, we summarize the latest clinical evidence regarding the use of CytoSorb\u00ae in sepsis, cardiac surgery, extracorporeal membrane oxygenation, hepatic diseases, rhabdomyolysis and burn injuries. Finally, we elaborated on the impact of CytoSorb\u00ae on the clearance rates of antibiotics and anticoagulants to address its safety concerns and highlighted ongoing debates on the timing, dose and patient selection criteria of CytoSorb\u00ae hemoadsorption, which requires future research to optimize actual benefits.<\/jats:p>","DOI":"10.3389\/fmed.2025.1628241","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:29:38Z","timestamp":1758518978000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["The use of CytoSorb hemoadsorption in critically ill patients: a narrative review"],"prefix":"10.3389","volume":"12","author":[{"given":"Kaixin","family":"Lei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinqi","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baihai","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yupei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"930673","DOI":"10.3389\/fimmu.2022.930673","article-title":"A vicious cycle: in severe and critically ill COVID-19 patients","volume":"13","author":"Huang","year":"2022","journal-title":"Front Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1159\/000529294","article-title":"Hemoperfusion: Indications, dose, prescription","volume":"200","author":"Bidar","year":"2023","journal-title":"Contrib Nephrol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1186\/s13054-022-04098-7","article-title":"Right dose, right now: bedside, real-time, data-driven, and personalised antibiotic dosing in critically ill patients with sepsis or septic shock-a two-Centre randomised clinical trial","volume":"26","author":"Roggeveen","year":"2022","journal-title":"Crit Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"105","DOI":"10.3233\/CH-221579","article-title":"Cytokine absorption in critically ill old COVID-19 patients with renal failure: a retrospective analysis of 503 intensive care unit patients","volume":"85","author":"Binneboessel","year":"2022","journal-title":"Clin Hemorheol Microcirc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s13054-023-04391-z","article-title":"Cytosorb hemoperfusion markedly attenuates circulating cytokine concentrations during systemic inflammation in humans in vivo","volume":"27","author":"Jansen","year":"2023","journal-title":"Crit Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1007\/s00134-022-06810-1","article-title":"Hemoperfusion in the intensive care unit","volume":"48","author":"Ricci","year":"2022","journal-title":"Intensive Care Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1159\/000485603","article-title":"Membranes and sorbents","volume":"194","author":"Clark","year":"2018","journal-title":"Contrib Nephrol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1007\/s00134-018-5464-6","article-title":"Hemoadsorption with CytoSorb\u00ae","volume":"45","author":"Poli","year":"2019","journal-title":"Intensive Care Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s13054-019-2399-4","article-title":"Cytokine clearance with CytoSorb\u00ae during cardiac surgery: a pilot randomized controlled trial","volume":"23","author":"Poli","year":"2019","journal-title":"Crit Care"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s13613-022-01017-5","article-title":"Does the cytokine adsorber CytoSorb\u00ae reduce vancomycin exposure in critically ill patients with sepsis or septic shock? 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