The complex landscape of critical care has expanded to include a variety of extracorporeal organ support therapies. Intensive care units now face complex clinical scenarios, such as septic shock, multiorgan failure, Acute Respiratory Distress Syndrome (ARDS), and infections resistant to standard treatments. Technologies like hemoadsorption and extracorporeal membrane oxygenation (ECMO) have emerged as potentially lifesaving interventions. Devices such as Cytosorb, oXiris, and Jafron are increasingly utilized to combat severe inflammatory responses. Meanwhile, continuous renal replacement therapy (CRRT) continues to play a crucial role in providing renal support for patients in critical care settings. Despite these advancements, new challenges—particularly related to antibiotic dosing and drug pharmacokinetics and pharmacodynamics—have surfaced and require dedicated exploration to optimize therapeutic outcomes.

This Research Topic aims to illuminate the clinical and scientific challenges encountered with the application of extracorporeal procedures in critically ill patients. Hemoadsorption therapies, including Cytosorb, oXiris, and Jafron, as well as CRRT and venovenous ECMO (VV ECMO), show potential to modulate systemic inflammatory responses effectively. However, the optimal use, timing, and patient selection are areas lacking consensus, further complicated by distinct impacts on antibiotic pharmacokinetics that may result in suboptimal drug levels. The overarching goal is to consolidate current advances, research, and expert insight to elucidate these therapies' precise roles within modern intensive care practices.

The scope of this Research Topic covers the breadth and depth of extracorporeal therapies in critical care while highlighting the complexities in antimicrobial management strategies. We welcome articles addressing, but not limited to, the following themes:

• Impact of hemoadsorption on cytokine storms in critical illness

• Future directions in continuous renal replacement therapy

• Application of ECMO technology in sepsis and ARDS

• Variations in antibiotic pharmacokinetics and pharmacodynamics due to extracorporeal interventions

• Integrative approaches combining clinical data with pharmacological modeling

Manuscripts may include Original Research, Clinical Trials, Reviews, Case Reports, and Systematic Reviews. Studies marrying clinical data with pharmacological modeling are particularly encouraged.

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Extracorporeal Organ Support: Innovations and Challenges in Critical Care