Zsolt Molnár

• 3. CytoSorb + HF 440
  Zsolt MolnárHungary Speaker Managing Patients with Sepsis: modifying the course with ECOSA dysregulated host response to infection is central to the pathophysiology of sepsis and may culminate in life-threatening organ dysfunction. Given that this process is largely characterized by concurrent pro- and anti-inflammatory activation, immunomodulatory strategies have long been explored in sepsis research. Among these, extracorporeal removal of circulating cytokines, inflammatory mediators and other soluble factors through non-specific hemoadsorption with macroporous styrene-divinylbenzene sorbents has been proposed as a potential therapeutic approach. Its adoption into clinical practice has largely been based on pathophysiological considerations rather than on evidence from large, well-designed randomized clinical trials. Over the past 15 years, most of the available evidence has been predominantly derived from small, single-center cohorts, reports from registries and heterogeneous prospective studies with substantial variability in patients’ selection, timing, and treatment intensity. In addition, the precise mechanisms of action of hemoadsorption remain incompletely understood. Although several meta-analyses have attempted to synthesize the existing data, the overall quality and heterogeneity of the included studies limit the strength and reliability of their conclusions. As a result, current guideline recommendations are largely based on expert opinions rather than high-certainty evidence. This presentation aims to provide a concise overview of the biological rationale, current evidence, and contemporary clinical practice related to hemoadsorption in sepsis.Multimodal individualized hemodynamic managementAchieving hemodynamic stability in the critically ill patents has a pivotal role in ensuring positive outcomes. The pathomechanism is complex and include impaired myocardial contractility, relative or absolute intravascular hypovolaemia, bradycardia, and thus eventually impaired blood flow. Arterial pressure can be monitored continuously, which makes it the most important and feasible tool to assess circulation in real time. A given level of the mean arterial pressure (MAP) is often regarded as the main target to be normalized in several guidelines. However, it is not the sole determinant of organ perfusion pressure and, although coupled to blood flow, is not a surrogate of blood flow or tissue perfusion. Conversely, normotension does not guarantee adequate organ blood flow and may just mimic ‘occult hypoperfusion’. Therefore, achieving hemodynamic coherence between macro- and microcirculation should be our pivotal aim during resuscitation and hemodynamic management. This requires a complex approach that is called multimodal, individualised, contextualised management that takes into account all measurable components of oxygen delivery and consumption, organ perfusion and cardiac output. How to do it at the bedside, will be presented on this lecture.
• 4. ECMO with CRRT, Plasmaphresis
  Keith Wille Speaker Connectology with Hybrid Systems: ECMO, Apheresis, ECCO2RExtracorporeal life support technologies are increasingly used in critical care settings, with integrating extracorporeal membrane oxygenation (ECMO), apheresis, and extracorporeal carbon dioxide removal (ECCO₂R) to provide multi-organ support. This session explores the principles, clinical applications, and challenges of extracorporeal systems and their integration into CRRT, focusing on the interaction between ECMO and renal replacement therapy (CRRT), the role of ECCO2R in respiratory failure, and the combination of apheresis for immunomodulation. Through discussion, participants will gain an understanding of patient selection, circuit configurations, anticoagulation strategies, and the physiological considerations that impact patient outcomes. Emphasis will be placed on optimizing patient management, recognizing complications, and developing a structured approach to hybrid extracorporeal therapy.AKI in Mechanical Circulatory SupportAcute kidney injury (AKI) is a frequent and important complication of cardiogenic shock and is strongly associated with adverse outcomes. Its pathogenesis is multifactorial, reflecting reduced cardiac output and renal perfusion, venous congestion, neurohormonal activation, systemic inflammation, vasopressor exposure, and hemodynamic instability. Mechanical circulatory support (MCS) may interrupt this cycle by restoring cardiac output, reducing venous congestion, and decreasing vasopressor requirements; however, MCS itself may contribute to kidney injury through hemolysis, embolic events, limb ischemia and rhabdomyolysis, bleeding, contrast exposure, and device-related hemodynamic disturbances. This presentation will review the mechanisms and clinical impact of AKI across commonly used temporary and durable MCS platforms, including intra-aortic balloon pumps, microaxial flow pumps, temporary ventricular assist devices, and durable LVADs. Particular emphasis will be placed on identifying potentially reversible contributors to AKI, understanding the relationship between timing of circulatory support and renal recovery, and managing patients who require concurrent kidney replacement therapy. Practical considerations for CRRT, including vascular access, anticoagulation, ultrafiltration, and interactions between CRRT and MCS, will also be discussed. How do I care for the Patient with ARDS and AKIAcute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) frequently coexist in critically ill patients and together are associated with substantial morbidity and mortality. Their management is closely intertwined: mechanical ventilation, positive end-expiratory pressure, hemodynamic support, and fluid administration may influence renal perfusion and venous congestion, while AKI and fluid accumulation can worsen pulmonary edema, impair gas exchange, and complicate ventilator management. This presentation will provide a practical approach to the patient with concurrent ARDS and AKI, integrating pulmonary and kidney-focused strategies. Key topics will include lung-protective ventilation and its renal consequences, assessment and management of volume status, the role of conservative fluid strategies and de-resuscitation, and the use of diuretics and kidney replacement therapy to achieve fluid-balance goals. Attention will be given to when and how continuous renal replacement therapy can support fluid management in patients with severe respiratory failure, including those with hemodynamic instability. The session will emphasize coordinated decision-making between critical care and nephrology teams to balance lung protection, kidney perfusion, and overall organ support.

  Nuttha LumlertgulThailand Speaker Solution and Fluid BalanceUtility of Lung Ultrasound, VEXUS and Bioimpedance Analysis in Volume Assessment During RRTPersonalized Fluid Management with CRRT

• Opening
• The Rationale for Hemoadsorption in the Critically Ill: Sepsis and Beyond
  Zsolt MolnárHungary Speaker Managing Patients with Sepsis: modifying the course with ECOSA dysregulated host response to infection is central to the pathophysiology of sepsis and may culminate in life-threatening organ dysfunction. Given that this process is largely characterized by concurrent pro- and anti-inflammatory activation, immunomodulatory strategies have long been explored in sepsis research. Among these, extracorporeal removal of circulating cytokines, inflammatory mediators and other soluble factors through non-specific hemoadsorption with macroporous styrene-divinylbenzene sorbents has been proposed as a potential therapeutic approach. Its adoption into clinical practice has largely been based on pathophysiological considerations rather than on evidence from large, well-designed randomized clinical trials. Over the past 15 years, most of the available evidence has been predominantly derived from small, single-center cohorts, reports from registries and heterogeneous prospective studies with substantial variability in patients’ selection, timing, and treatment intensity. In addition, the precise mechanisms of action of hemoadsorption remain incompletely understood. Although several meta-analyses have attempted to synthesize the existing data, the overall quality and heterogeneity of the included studies limit the strength and reliability of their conclusions. As a result, current guideline recommendations are largely based on expert opinions rather than high-certainty evidence. This presentation aims to provide a concise overview of the biological rationale, current evidence, and contemporary clinical practice related to hemoadsorption in sepsis.Multimodal individualized hemodynamic managementAchieving hemodynamic stability in the critically ill patents has a pivotal role in ensuring positive outcomes. The pathomechanism is complex and include impaired myocardial contractility, relative or absolute intravascular hypovolaemia, bradycardia, and thus eventually impaired blood flow. Arterial pressure can be monitored continuously, which makes it the most important and feasible tool to assess circulation in real time. A given level of the mean arterial pressure (MAP) is often regarded as the main target to be normalized in several guidelines. However, it is not the sole determinant of organ perfusion pressure and, although coupled to blood flow, is not a surrogate of blood flow or tissue perfusion. Conversely, normotension does not guarantee adequate organ blood flow and may just mimic ‘occult hypoperfusion’. Therefore, achieving hemodynamic coherence between macro- and microcirculation should be our pivotal aim during resuscitation and hemodynamic management. This requires a complex approach that is called multimodal, individualised, contextualised management that takes into account all measurable components of oxygen delivery and consumption, organ perfusion and cardiac output. How to do it at the bedside, will be presented on this lecture.
• Q & A

• Managing Patients with Sepsis: Modifying the Course with ECOS
  Thomas RimmeléFrance Speaker Managing Patients with Sepsis: Modifying the Course with ECOSImmune Disorders of AKI Patients Following Various Types of Injuries ?How Do I Use Hemadsorption in My Practice

  Zsolt MolnárHungary Speaker Managing Patients with Sepsis: modifying the course with ECOSA dysregulated host response to infection is central to the pathophysiology of sepsis and may culminate in life-threatening organ dysfunction. Given that this process is largely characterized by concurrent pro- and anti-inflammatory activation, immunomodulatory strategies have long been explored in sepsis research. Among these, extracorporeal removal of circulating cytokines, inflammatory mediators and other soluble factors through non-specific hemoadsorption with macroporous styrene-divinylbenzene sorbents has been proposed as a potential therapeutic approach. Its adoption into clinical practice has largely been based on pathophysiological considerations rather than on evidence from large, well-designed randomized clinical trials. Over the past 15 years, most of the available evidence has been predominantly derived from small, single-center cohorts, reports from registries and heterogeneous prospective studies with substantial variability in patients’ selection, timing, and treatment intensity. In addition, the precise mechanisms of action of hemoadsorption remain incompletely understood. Although several meta-analyses have attempted to synthesize the existing data, the overall quality and heterogeneity of the included studies limit the strength and reliability of their conclusions. As a result, current guideline recommendations are largely based on expert opinions rather than high-certainty evidence. This presentation aims to provide a concise overview of the biological rationale, current evidence, and contemporary clinical practice related to hemoadsorption in sepsis.Multimodal individualized hemodynamic managementAchieving hemodynamic stability in the critically ill patents has a pivotal role in ensuring positive outcomes. The pathomechanism is complex and include impaired myocardial contractility, relative or absolute intravascular hypovolaemia, bradycardia, and thus eventually impaired blood flow. Arterial pressure can be monitored continuously, which makes it the most important and feasible tool to assess circulation in real time. A given level of the mean arterial pressure (MAP) is often regarded as the main target to be normalized in several guidelines. However, it is not the sole determinant of organ perfusion pressure and, although coupled to blood flow, is not a surrogate of blood flow or tissue perfusion. Conversely, normotension does not guarantee adequate organ blood flow and may just mimic ‘occult hypoperfusion’. Therefore, achieving hemodynamic coherence between macro- and microcirculation should be our pivotal aim during resuscitation and hemodynamic management. This requires a complex approach that is called multimodal, individualised, contextualised management that takes into account all measurable components of oxygen delivery and consumption, organ perfusion and cardiac output. How to do it at the bedside, will be presented on this lecture.

  Bang-Gee HsuTaiwan Moderator

  YU-FENG LINTaiwan Moderator

• Trajectories of Critical Illness – Defining Endotypes from Routine Data
  John ProwleUnited Kingdom Speaker Trajectories of Critical Illness – Defining Endotypes from Routine DataCritical illness is a heterogeneous syndrome characterized by diverse clinical trajectories and variable responses to treatment. Defining biologically and clinically meaningful endotypes using routinely collected healthcare data offers an opportunity to improve risk stratification, prognostication, and personalized therapeutic strategies, enabling earlier intervention, enhanced clinical decision-making, and precision medicine in critical care. In particular the transition from acute to persistent critical illness represents a pivotal phase in intensive care, marked by a shift from the initial disease insult to prolonged organ dysfunction driven by complex host responses. Early identification of patients at risk of this transition remains a major clinical challenge and opportunity.Dynamic Prescription of CRRT Ready for Prime TimeContinuous renal replacement therapy (CRRT) has evolved from a standardized supportive therapy to a platform for precision critical care. Increasing evidence suggests that fixed prescriptions fail to accommodate the dynamic physiological changes encountered during critical illness, resulting in suboptimal solute clearance, fluid management, and metabolic control. Dynamic prescription integrates evolving haemodynamic status, fluid balance, acid–base homeostasis, electrolyte disturbances, and recovery trajectories to optimize therapy delivery while minimizing complications and treatment interruptions. This paradigm supports individualized kidney support rather than protocol-driven care. Emerging decision-support systems and data-driven algorithms have the potential to transform CRRT into a responsive, patient-centred intervention, improving kidney recovery, organ support, and outcomes in critically ill patients. Adapting CRRT for patients with Electrolyte and acid-base disordersContinuous renal replacement therapy (CRRT) is uniquely positioned to provide precise correction of complex electrolyte and acid–base disturbances in critically ill patients. Beyond kidney support, modern CRRT prescriptions can be individualized to account for the severity and evolution of dysnatremia, dyskalemia, calcium disorders, and metabolic acidosis or alkalosis. Customization of dialysate and replacement fluid composition, treatment dose, buffer delivery, and regional citrate anticoagulation enables controlled correction while minimizing the risks of metabolic complications. Dynamic prescription based on serial biochemical monitoring and changing clinical physiology can be embedded into treatment protocols, facilitating safe correction of sodium, potassium, calcium, and bicarbonate abnormalities while optimizing organ support and improving outcomes in critically ill patients. Extracorporeal Therapies in Trauma, Burns and Cerebral OedemaExtracorporeal therapies (ECTs) are an important adjunct in the management of critically ill patients with severe trauma, major burns, and brain injuries. Acute kidney injury, systemic inflammation, rhabdomyolysis, and profound fluid and electrolyte disturbances frequently complicate these conditions, necessitating timely organ support. Continuous kidney replacement therapy (CKRT) provides effective management of metabolic derangements while enabling precise fluid balance in hemodynamically unstable patients. In trauma and burns, ECTs may facilitate the clearance of myoglobin in severe rhabdomyolysis, support fluid management during resuscitation, and could enable removal of damage or pathogen associated molecular patterns mediating multiorgan failure. In patients with cerebral edema, CKRT offers gradual osmotic control and minimizes intracranial pressure fluctuations compared with intermittent dialysis, making it the preferred modality when kidney replacement therapy is required. We will review current evidence, practical considerations, and emerging extracorporeal strategies, highlighting their role in improving physiological stability and supporting recovery in critically ill patients.
• Multimodal individualized hemodynamic management
  Zsolt MolnárHungary Speaker Managing Patients with Sepsis: modifying the course with ECOSA dysregulated host response to infection is central to the pathophysiology of sepsis and may culminate in life-threatening organ dysfunction. Given that this process is largely characterized by concurrent pro- and anti-inflammatory activation, immunomodulatory strategies have long been explored in sepsis research. Among these, extracorporeal removal of circulating cytokines, inflammatory mediators and other soluble factors through non-specific hemoadsorption with macroporous styrene-divinylbenzene sorbents has been proposed as a potential therapeutic approach. Its adoption into clinical practice has largely been based on pathophysiological considerations rather than on evidence from large, well-designed randomized clinical trials. Over the past 15 years, most of the available evidence has been predominantly derived from small, single-center cohorts, reports from registries and heterogeneous prospective studies with substantial variability in patients’ selection, timing, and treatment intensity. In addition, the precise mechanisms of action of hemoadsorption remain incompletely understood. Although several meta-analyses have attempted to synthesize the existing data, the overall quality and heterogeneity of the included studies limit the strength and reliability of their conclusions. As a result, current guideline recommendations are largely based on expert opinions rather than high-certainty evidence. This presentation aims to provide a concise overview of the biological rationale, current evidence, and contemporary clinical practice related to hemoadsorption in sepsis.Multimodal individualized hemodynamic managementAchieving hemodynamic stability in the critically ill patents has a pivotal role in ensuring positive outcomes. The pathomechanism is complex and include impaired myocardial contractility, relative or absolute intravascular hypovolaemia, bradycardia, and thus eventually impaired blood flow. Arterial pressure can be monitored continuously, which makes it the most important and feasible tool to assess circulation in real time. A given level of the mean arterial pressure (MAP) is often regarded as the main target to be normalized in several guidelines. However, it is not the sole determinant of organ perfusion pressure and, although coupled to blood flow, is not a surrogate of blood flow or tissue perfusion. Conversely, normotension does not guarantee adequate organ blood flow and may just mimic ‘occult hypoperfusion’. Therefore, achieving hemodynamic coherence between macro- and microcirculation should be our pivotal aim during resuscitation and hemodynamic management. This requires a complex approach that is called multimodal, individualised, contextualised management that takes into account all measurable components of oxygen delivery and consumption, organ perfusion and cardiac output. How to do it at the bedside, will be presented on this lecture.
• Utility of Lung Ultrasound, VEXUS and Bioimpedance Analysis in Volume Assessment During RRT
  Nuttha LumlertgulThailand Speaker Solution and Fluid BalanceUtility of Lung Ultrasound, VEXUS and Bioimpedance Analysis in Volume Assessment During RRTPersonalized Fluid Management with CRRT
• Immune Disorders of AKI Patients Following Various Types of Injuries ?
  Thomas RimmeléFrance Speaker Managing Patients with Sepsis: Modifying the Course with ECOSImmune Disorders of AKI Patients Following Various Types of Injuries ?How Do I Use Hemadsorption in My Practice
• Critical Care Nephrology: Literature Review
  Kianoush KashaniUnited States Speaker Practical Steps to Train (and Become) an AI-Era PhysicianAI in Critical Care Nephrology — State of the Art and the Path from Algorithm to BedsideCritical Care Nephrology: Literature ReviewChat GPT Applications in Critical Care Nephrology
• Q & A