Rescue therapy with polymyxin B hemoperfusion in high-dose vasopressor therapy refractory septic shock

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Nephrology

Background:

• Refractory septic shock (RSS) with Gram-negative infections carries high mortality.
• High-dose vasopressor therapy (HDVT) is often required but associated with poor outcomes.
• Limited rescue therapies exist for patients with multiple organ failure (MOF) and RSS.

Purpose of the Study:

• To evaluate Polymyxin B hemoperfusion (PMX-HP) as a rescue therapy for RSS patients on HDVT.
• To describe the hemodynamic, organ function, and clinical outcomes in this patient cohort.
• To identify factors influencing mortality in RSS patients treated with PMX-HP.

Main Methods:

• Retrospective analysis of 52 patients with RSS requiring HDVT (norepinephrine/epinephrine ≥ 0.5 µg/kg/min) and ≥ 2 organ failures.
• Patients received two sessions of PMX-HP for suspected/confirmed Gram-negative infections.
• Hemodynamics, vasopressor requirements, organ function, and 30-day mortality were assessed.

Main Results:

• PMX-HP significantly improved mean arterial pressure (MAP) and reduced vasopressor (NEP+EP) requirements by 76% within 72 hours.
• Pulmonary and renal function showed significant improvement post-PMX-HP.
• Early responders (≥50% NEP+EP reduction within 24h) had a 16% 30-day mortality versus 45% in early non-responders.

Conclusions:

• PMX-HP demonstrates a potential role as a rescue therapy for refractory septic shock with high-dose vasopressor needs.
• The therapy improved hemodynamic stability and organ function in critically ill patients.
• A 30-day survival rate of up to 70% was observed, suggesting PMX-HP's efficacy in improving outcomes.