Early management of endotoxemia using the endotoxin activity assay and polymyxin B-based hemoperfusion

We evaluated the ability of the endotoxin activity (EA) assay to determine the need for early intervention for endotoxemia using polymyxin B-based hemoperfusion (PMX-DHP) on septic patients.

Twenty-four patients were enrolled. Eleven patients had a high EA level (> or = 0.6) and were treated with PMX-DHP every 24 h until the EA level was low ( < 0.4). The remaining 13 patients had EA levels < 0.60 and received standard therapy only.

Two PMX-DHP treatments were performed on 4 patients, three treatments on 6 patients and four treatments on 1 patient. After the therapy, mean arterial pressure increased (69.45 to 84.09 mm Hg; p < 0.01), heart rate decreased (Ill.73 to77.91 beats/min; p < 0.01), white blood cell count decreased (18,380 to 9,550 cells/mm(3); p < 0.01), the PMN (polymorphonuclear) percentage decreased (88.45 to 67.82%; p < 0.01) and PaO(2)/FiO(2) increased (275 to 308.09; p < 0.01). All 24 patients survived to the 28-day follow-up.

The EA assay can identify patients eligible for PMX-DHP treatment and aids its therapeutic dosing.