Extracorporeal Blood Purification and Acute Injury in Cardiac Surgery—Reply

In Reply We thank Drs Lieberman and LaHue for highlighting the importance that delirium has in the postoperative period of cardiac surgery, with a reported prevalence of up to 25% to 50%. We agree that organ dysfunction in patients undergoing cardiac surgery, especially those requiring cardiopulmonary bypass, must be evaluated as a whole picture and not only focused on a single organ end point. It seems very attractive to analyze the possible effect that a hypothetical removal of inflammatory mediators and damage-associated molecular patterns with the use of a nonselective EBP during cardiopulmonary bypass may have on the incidence of delirium. Previous data from the REMOVE trial point in this direction, although the EBP device used and the EBP settings (eg, blood flow) were different from those in our study. Nonselective EBP devices are capable of removing a large amount of molecules from the circulation, and this must be considered when performing the technique because some previously reported adverse effects (thrombocytopenia or heparin adsorption) could appear with the use of high blood flow.