Polymyxin B Hemoperfusion Shows Promise in Treating Septic Shock

Using polymyxin B hemoperfusion as a means of reducing endotoxin levels in blood can improve survival and other outcomes in patients with septic shock from intra-abdominal gram-negative infections, according to a new study.

Researchers at St. Bortolo Hospital (Vicenza, Italy) conducted a randomized trial that 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. The perfusion device used in the study consisted of a column containing polymyxin B--which has a high affinity for endotoxin--bound to polystyrene fibers.

The researchers found that 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. Additionally, organ dysfunction, as measured with the Sequential Organ Failure Assessment (SOFA) score improved significantly in the polymyxin B group, but not in controls; 28-day mortality in the polymyxin B group was 32%, compared with 53% in the control group, a risk reduction of 64%. The study was published in June 17, 2009 issue of the Journal of the American Medical Association (JAMA).

"The biggest finding was the reduction of mortality in the studied population,” said senior author Claudio Ronco, M.D. "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.

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