Volume 13 Supplement 1

29th International Symposium on Intensive Care and Emergency Medicine

Open Access

Lipopolysaccharide adsorber in abdominal septic shock

  • T Ala-Kokko1,
  • J Koskenkari1 and
  • J Laurila1
Critical Care200913(Suppl 1):P280

https://doi.org/10.1186/cc7444

Published: 13 March 2009

Introduction

Polymyxin-B hemoperfusion has been shown to lower mortality in sepsis [1]. The effects of a new endotoxin adsorber (Alteco LPS Adsorber; Alteco Medical AB, Lund, Sweden) on the length of noradrenaline (NA) treatment and lipopolysaccharide blood levels in abdominal septic shock were evaluated.

Methods

Following consent a 2-hour hemoperfusion with LPS adsorber was began in five patients [2]. Sepsis guidelines were followed [3]. Two historical controls per case were selected.

Results

The mean total duration of NA infusion was 46 hours shorter in the adsorber group compared with the control group (95% CI = -104 hours to 12 hours, P = 0.165) (Table 1). The average length of NA infusion was 17.4 ± 6.8 hours (5.8 to 23.8 hours) following the start of adsorption treatment. The level of LPS decreased in all but one study patient and all were without NA at 24 hours. The mean Sequential Organ Failure Assessment decrease was 3.4 ± 1.7 from baseline to 24 hours post treatment The average length of hospital stay was 3.4 days shorter in the adsorber group (95% CI of the difference, -21.7 to 14.8 days, P = 0.881). All study patients were alive on day 28 and one control died in the hospital.
Table 1

Clinical characteristics of the study patients and the controls

 

Patients

(n = 5)

Controls

(n = 10)

P value

Age

64 ± 16

65 ± 13

NS

Male/female

2/3

4/6

NS

Simplified Acute Physiology Score II

38 ± 11

46 ± 11

NS

Sequential Organ Failure Assessment

9.6 ± 2

7.7 ± 2

NS

ICU length of stay

6.2 ± 3

6.4 ± 3

NS

Hospital length of stay

23 ± 13

27 ± 17

NS

NA infusion (hours)

34 ± 12

81 ± 77

NS

Data presented as mean ± SD.

Conclusion

Single 2-hour LPS hemoperfusion was associated with a rapid decrease in NA dose, reversal of septic shock, and decrease in organ dysfunctions and LPS concentrations. The total duration of NA infusion and hospital stay were shorter compared with historical controls, but the difference was not statistically significant in this small study.

Authors’ Affiliations

(1)
Oulu University Hospital

References

  1. Cruz D, et al.: Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care 2007, 11: R47. 10.1186/cc5780PubMedPubMed CentralView ArticleGoogle Scholar
  2. Levy MM, et al.: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2001, 31: 1250-1256. 10.1097/01.CCM.0000050454.01978.3BView ArticleGoogle Scholar
  3. Dellinger RP, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41PubMedView ArticleGoogle Scholar

Copyright

© Ala-Kokko et al; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.

Advertisement