Can you tell us about one sepsis patient or your first encounter with sepsis that left a lasting impression? Looking back today, what did that experience teach you, and what continues to motivate you to care for these patients?

Dr. Ruszkai Zoltán: A 38-year-old woman was admitted to the emergency department with severe and progressively worsening pain in her left lower extremity. A few days earlier, she had sustained a minor injury to her left heel from a small stone in her shoe while walking. Initially, there were no significant visible local abnormalities; however, the pain progressively increased and she eventually became unable to stand or walk.

Following hospital admission, her clinical condition rapidly deteriorated. By the next morning, the left lower extremity had become markedly swollen with purple discoloration. Further evaluation revealed necrotizing fasciitis complicated by septic shock. She required multiple urgent surgical interventions and prolonged organ-supportive intensive care including mechanical ventilation, haemodynamic support, CRRT for 16 days, 2 rounds of adjuvant hemoadsoprtion and high dose intravenous immunoglobulin, while amputation of the affected limb was considered a significant risk.

Her total ICU stay was 44 days and due to extensive soft-tissue damage she required repeated reconstructive procedures (further 54 days), including skin grafting, followed by prolonged rehabilitation. Her total hospitalization exceeded 120 days.

Following discharge, functional recovery continued progressively. Fifty-three days after leaving hospital, she was able to complete a 400-metre run at a family sports event and subsequently returned to work. At follow-up, she had some residual functional impairment of the left lower extremity, including reduced walking speed and inability to squat, but had achieved substantial functional independence with preservation of the affected limb.

This experience reminded me that in intensive care, we are not simply treating sepsis, organ failure, or abnormal laboratory values: we are treating a person whose entire life can change within hours. We often see our patients during the darkest part of their journey. They may be unconscious, ventilated, and dependent on multiple forms of organ support, and we do not always get to see what happens months later. Seeing someone survive, return to their family, go back to work, and regain an almost normal life gives meaning to everything we do.

At the same time, cases like this remind me that survival is not the end of the story. Our responsibility is not only to keep patients alive, but also to give them the best possible chance of returning to a meaningful life. That is what continues to motivate me: knowing that behind every critically ill patient there is a person, a family, and a life worth fighting for.

Multimodal haemoadsorption has become part of the therapeutic toolbox for septic shock. From your clinical experience, how has it influenced the way you approach sepsis management? Have you noticed changes in your decision-making, patient management or outcomes?

Dr. Ruszkai Zoltán: Multimodal haemoadsorption has expanded our therapeutic options in selected patients with severe septic shock. In our practice, we mainly consider it as an adjunctive rescue therapy when conventional source control, antimicrobial treatment and haemodynamic support are not sufficient. We have observed encouraging responses in some patients, particularly in terms of haemodynamic stabilization and decreasing vasopressor requirements.

However, haemoadsorption is still not recommended as standard therapy by the latest Surviving Sepsis Campaign guidelines, and we clearly need stronger clinical evidence. This was one of the reasons why we initiated the HOPE-FUL Study, a retrospective analysis of all patients treated with haemoadsorption in our ICU over the past six years. Our primary focus is on changes in vasopressor dependency index (VDI) and vasoactive-inotropic score (VIS), to better understand whether haemoadsorption is associated with measurable haemodynamic improvement and to identify which patients may benefit most from this approach.

What gives you the greatest hope for the future of sepsis management? Which advances whether in early diagnosis, individualized treatment, extracorporeal therapies or multidisciplinary care do you believe will have the biggest impact over the next decade?

Dr. Ruszkai Zoltán: I believe the biggest impact will come from moving towards earlier recognition and truly personalised intensive care. Sepsis is not a single disease, and we need to identify different phenotypes and understand which patient needs which intervention, and at what time. Artificial intelligence, continuous physiological monitoring and new biomarkers may help us recognise deterioration earlier and guide treatment more precisely.

At the same time, extracorporeal therapies, including haemoadsorption, may become increasingly targeted rather than being applied broadly to all patients. The key will be better patient selection and timing, supported by high-quality clinical evidence. Ultimately, I think the future of sepsis care will be a combination of early diagnosis, precision medicine, targeted organ support and strong multidisciplinary teamwork.

In one sentence, what does 'Never Stop Fighting Sepsis' mean to you?

Dr. Ruszkai Zoltán: It means never giving up on our patients: from the first critical hours of sepsis through survival and recovery, all the way to returning to a meaningful life.