[Polymyxin B hemoperfusion (PMX-F) for severe sepsis and septic shock]

PMX-F, which was developed in Japan, is a potential therapeutic option for severe sepsis and septic shock. Despite positive effects on surrogate outcomes, demonstrated in methodologically suboptimal preliminary studies, its benefit on mortality remains unclear. Surprisingly, this expensive investigational therapy has been reimbursed by the Japanese National Health Insurance program since 1994 and 75,000 cartridges have been consumed, sometimes without expert intensive care supervision. Current evidence in intensive care medicine does not justify utilizing PMX-F for severe sepsis and septic shock, considering its unproven benefit, significant cost and potential risks. Even if reduced mortality is shown in future studies, that benefit could easily be cancelled out in settings, such as many Japanese institutions, where intensive care expertise is unavailable.