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Polymyxin-B endotoxin removal device: making the point on mechanisms of action, clinical effectiveness and possible

Franco Ruberto1, S Ianni, C Babetto

  • 1Department of Anesthesiology and Intensive Care Medicine, Sapienza Universita di Roma, Policlinico Umberto I, viale del Policlinico 155, 00161 Rome, Italy. rube2005@libero.it

Infectious Disorders Drug Targets
|August 8, 2013
PubMed

Insights

Polymyxin B (PMX) cartridges offer an effective apheresis method for removing endotoxins, improving patient outcomes in sepsis. Further research is needed to broaden its clinical applications.

Area of Science:

  • Medical Technology
  • Nephrology
  • Critical Care Medicine

Background:

  • Endotoxins from Gram-negative bacteria are a major cause of sepsis.
  • Intravenous Polymyxin B is toxic, limiting its use.
  • Polymyxin B cartridges (PMX) were developed to safely remove endotoxins via apheresis.

Purpose of the Study:

  • To review current information on apheresis procedures using Polymyxin B cartridges for endotoxin removal.
  • To summarize the mechanisms, clinical use, and effectiveness of PMX in sepsis treatment.
  • To highlight the need for further research to expand PMX applications.

Main Methods:

  • Review of over one hundred published studies on the clinical use of PMX cartridges.
  • Analysis of data on clinical condition, hemodynamic parameters, respiratory function (PaO2/FiO2 ratio), and severity scores (APACHE, SOFA).
  • Evaluation of patient outcomes, including 28-day survival, across various sepsis types.

Main Results:

  • PMX apheresis demonstrates a positive impact on clinical condition and patient outcomes.
  • Studies show improvements in hemodynamic stability, PaO2/FiO2 ratio, and reduced severity scores.
  • Benefits are observed in diverse sepsis cases, including those in transplanted patients.

Conclusions:

  • Polymyxin B cartridges are a promising tool for treating Gram-negative and endotoxin sepsis.
  • PMX offers clinical and outcome improvements with a favorable cost-effectiveness ratio.
  • Wider, structured clinical studies are required to solidify PMX use and expand its indications.

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