Polymyxin B hemoperfusion in high endotoxin activity level septic shock patients

Introduction

The aim of the study was to evaluate the clinical impact of polymyxin-B hemoperfusion (HP-PMX) as adjuvant therapy versus conventional treatment in septic shock (SS) patients with high endotoxemia.

Methods

A retrospective analysis of the clinical profile and evolution related to the treatment strategy of SS patients with a high endotoxin activity (EA) level (>0.6 units) attending our ICU from January to August 2007. All patients (n = 16) were treated with standard therapy (ST) according to the Surviving Sepsis Campaign. According to our ICU practice, adjuvant therapy with HP-PMX (twice, 2 hours/session with an interval of 24 hours) was performed only in SS patients with known or presumed Gram-negative and Gram-positive infections, worsening of haemodynamic instability in the next 6 hours of diagnosis and ≥ 3 organ failures (PMX group, n = 8). The clinical profile was evaluated in the two groups (ST vs PMX group) at T0 (SS diagnosis, start of HP-PMX) and at T1 (at 48 hours). The Student t test for paired values was used for statistical purpose (P < 0.05 significant).

Results

At T0, the clinical profile of the two groups of high EA level SS patients was similar (EA level, age, SOFA score, mean arterial pressure, norepinephrine, lactates, PaO₂/FiO₂, continuous renal replacement therapy, used of activated protein C). Otherwise the PMX group showed a significant improvement of clinical conditions compared with the ST group at T1 (Table 1). The ICU length of stay was significantly longer in the PMX group versus the ST group (21.5 ± 21.3 vs 53.6 ± 67 days, P < 0.05). Further PMX-HP resulted in a reduction of ICU mortality when compared with ST in high EA level SS patients, probably due to endotoxin removal (45% vs 16%, not significant due to small sample size).

Table 1 Evolution of high endotoxin activity level in septic shock patients

Conclusion

We can question whether the EA level could be a useful guide to early institution of specific anti-lipopolysaccharide treatments.