Nursing Care for Patients with Septic Shock Undergoing Hemoperfusion Therapy

Abstract

Septic shock is a severe complication of infection, closely associated with immune dysregulation resulting from an overwhelming host response. This condition leads to profound circulatory abnormalities and ultimately progresses to multiple organ dysfunction syndrome (MODS). Septic shock remains a major cause of mortality among critically ill patients. Standard treatment strategies emphasize the prompt administration of antibiotics, effective source control, and stabilization of hemodynamic balance. However, in certain cases, these measures may not adequately suppress the inflammatory response. Recent advances in extracorporeal blood purification technologies have introduced hemoperfusion therapy as an adjunctive approach in the management of septic shock. The primary objective of this therapy is to remove pro-inflammatory mediators, such as endotoxins and cytokines, from the bloodstream. By reducing circulating levels of these mediators, hemoperfusion may attenuate systemic inflammation, restore immune homeostasis, and improve hemodynamic stability, thereby potentially enhancing patient survival. Critical care nurses play a pivotal role in the holistic management of patients undergoing hemoperfusion therapy. Their responsibilities include comprehensive patient assessment, vigilant monitoring of clinical status, and prevention of treatment-related complications. Systematic nursing care facilitates the early detection of abnormalities and contributes significantly to the overall effectiveness of therapy. This article aims to synthesize and present empirical knowledge regarding nursing care for patients with septic shock undergoing hemoperfusion therapy. The content is organized into four key domains: (1) Principles of hemoperfusion, an extracorporeal blood purification technique based on adsorption, which removes inflammatory mediators and toxins from the bloodstream through high-surface-area sorbent materials with specific binding properties. These materials effectively capture medium- to large-sized molecules such as cytokines, endotoxins, and other pro-inflammatory substances implicated in the pathophysiology of sepsis. This process reduces circulating inflammatory mediators, thereby attenuating systemic inflammation and restoring immune balance, (2) Systematic patient assessment and monitoring before, during, and after therapy, with emphasis on close observation of vital signs, hemodynamic status, and the function of major organ systems including cardiovascular, renal, and respiratory systems as well as laboratory parameters related to inflammation and organ function (e.g., lactate levels, renal function tests, and inflammatory markers). Vascular access readiness is also evaluated to ensure effective extracorporeal circulation, (3) Prevention and management of potential complications associated with hemoperfusion therapy, including hypotension, circuit clotting, thrombocytopenia, hypothermia, fluid and electrolyte imbalances, and complications related to central venous catheter insertion. Continuous surveillance enables early detection and timely intervention, and (4) System and process management of hemoperfusion therapy, encompassing preparation of equipment and devices, verification of circuit readiness, adjustment of machine settings according to patient condition and treatment plan, vascular access care, infection control, systematic documentation of clinical data, and interdisciplinary team coordination. These elements are essential to ensure that therapy is delivered effectively and in accordance with critical care standards. The knowledge presented in this article provides a framework for advancing nursing practice in the care of patients with septic shock receiving hemoperfusion therapy, thereby promoting the quality and efficiency of critical care nursing.