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Polymyxin B hemoperfusion shows promise for septic shock

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Using polymyxin B hemoperfusion as a means of reducing endotoxin levels in the blood can improve survival and other outcomes in patients with septic shock from intra-abdominal gram-negative infections, new research suggests.

The perfusion device consists of a column containing polymyxin B, which has a high affinity for endotoxin, bound to polystyrene fibers.

“The biggest finding was the reduction of mortality in the studied population,” senior author Dr. Claudio Ronco, from St. Bortolo Hospital, Vicenza, Italy, told Reuters Health. “Although we suspected from previous studies a possible benefit in terms of blood pressure and lung function, we were positively surprised at finding a significant effect on survival.”

Circulating endotoxin is thought to play a key role in the clinical manifestations of gram-negative-induced abdominal sepsis, but whether reducing endotoxin levels would improve outcomes was unclear, according to the report in the Journal of the American Medical Association for June 17.

The EUPHAS (Early Use of Polymyxin B Hemoperfusion in Abdominal Sepsis) trial involved 64 patients with septic shock or severe sepsis who underwent emergency surgery for an intra-abdominal infection. The subjects were randomized to receive conventional therapy with or without polymyxin B hemoperfusion.

Polymyxin B hemoperfusion was associated with a significant increase in mean arterial pressure and with a decrease in vasopressor requirement. Likewise, the PaO2/FiO2 ratio also increased slightly with this intervention.

Twenty-eight day mortality in the polymyxin B group was 32% compared with 53% in the control group, a risk reduction of 64%. Moreover, organ dysfunction, as measured with the Sequential Organ Failure Assessment score, improved significantly in the polymyxin B group, but not in controls (p < 0.001).

“Larger multicenter studies are indicated to confirm these encouraging findings in other patient populations,” the authors state. “Furthermore, we advocate further studies to explore the use of newer assays for endotoxin activity both for patient selection, as well as guiding the number of hemoperfusion sessions.”

Reference:
JAMA 2009;301:2445-2452.