Beneficial effects of early hemoperfusion with a polymyxin B fibre column on septic shock

Introduction

The aim was to verify the hypothesis that extracorporeal therapy with a polymyxin B (PMX) fibre column may prevent septic shock-induced organ dysfunction and that early treatment of septic shock with PMX hemoperfusion may improve patient outcome.

Methods

One hundred and sixteen patients with septic shock who were admitted to the ICU of 35 hospitals were enrolled in this study from April 2006 through March 2008. PMX treatment was performed immediately after septic shock was diagnosed. All patients were followed up for 28 days after enrollment in the study, and 28-day mortality was assessed. Arachidonylethanolamide, 2-arachidonoylglycerol, IL-6, lipopolysaccharide, lactic acid, and the Sepsis-related Organ Failure Assessment score were determined before PMX treatment and at 24, 72, and 168 hours after the treatment.

Results

At the end of PMX treatment, the mean arterial pressure and plasma HCO₃^- were significantly increased (P < 0.01), and the plasma level of lactate was significantly decreased (P < 0.05). Seven days after treatment, the PaO₂/FiO₂ ratio was significantly increased (P < 0.05), and the plasma level of creatinine and arachidonylethanolamide were significantly decreased (P < 0.05). Of the 57 surviving patients, 24 patients were treated with PMX within 6 hours after the diagnosis of the septic shock (early group) and 33 did not treat within 6 hours (late group). There was no significant difference between the early and late groups about 28-day mortality (41.5% and 37.7%, respectively; P = NS), whereas serum creatinine and the PaO₂/FiO₂ ratio were significantly improved (P < 0.05). The ICU stay was shorter in the early group than the late group (10.6 vs. 16.4 days; P = 0.088).

Conclusion

Hemoperfusion with PMX was a safe and effective treatment for improvement of hypotension and hypoperfusion in septic shock patients. PMX treatment within 6 hours after diagnosis of septic shock would be beneficial with respect to oxygenation and renal function.