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Efficacy of postoperative polymyxin B hemoperfusion in secondary peritonitis patients with septic shock: a
Kuo-Ching Yuan1, Shang-Yu Wang1, Ming-Chin Yu2
1Division of Trauma and Emergency Surgery, Department of Surgery, Chang-Gung Memorial Hospital, Taipei - Taiwan.
Introduction:
Severe sepsis and septic shock is still a challenge. Polymyxin B hemoperfusion (PMX) is a device designed to remove circulating endotoxin by adsorption, which is reported to improve treatment outcomes. This study aimed to further verify the efficacy of PMX on postoperative, peritonitis, septic shock patients.
Methods:
This study prospectively analyzed 20 of 155 patients who presented with postoperative septic shock and were treated with PMX in a single institute during the period March 2013 to September 2014 (Clinical Trial Protocol number: ChiCTR-ONC-16008160). A control group (53 patients) was recruited from our own 2012 database using the propensity-matching score method. The data collection includes demographic data, postoperative organ dysfunction status, disease severity and treatment result.
Results:
The 2 groups (treatment vs. control) were similar in demographic data, organ dysfunction status and disease severity. PMX use provides benefits for recovery of hemodynamic status and many other aspects, including better survival, but is not statistically significant. For survival factor analysis, PMX use is also not significant for patient survival in our study.
Conclusions:
PMX provided some benefits to patients in the treatment for peritonitis septic shock. An improvement in hemodynamic status was mostly observed. Our study also supports the finding that PMX used as an auxiliary treatment provides improved survival but is not statistically significant, possibly due to the small sample size with multiple comorbidities.
Insights
Polymyxin B hemoperfusion (PMX) showed benefits for septic shock patients, improving hemodynamic status. While survival benefits were observed, they were not statistically significant in this study.
Area of Science:
- Critical Care Medicine
- Nephrology
- Infectious Diseases
Background:
- Severe sepsis and septic shock remain significant clinical challenges.
- Polymyxin B hemoperfusion (PMX) is an extracorporeal device designed for endotoxin adsorption.
- Previous reports suggest PMX may improve treatment outcomes in sepsis.
Purpose of the Study:
- To evaluate the efficacy of Polymyxin B hemoperfusion (PMX) in patients with postoperative peritonitis and septic shock.
- To further verify the clinical benefits of PMX in a specific patient cohort.
Main Methods:
- Prospective analysis of 20 patients treated with PMX for postoperative septic shock.
- Comparison with a propensity score-matched control group of 53 patients from a 2012 database.
- Data collected included demographics, organ dysfunction, disease severity, and treatment outcomes.
Main Results:
- No significant differences in demographic data, organ dysfunction, or disease severity between PMX and control groups.
- PMX treatment showed a trend towards improved hemodynamic status and survival, but without statistical significance.
- Survival analysis indicated PMX was not a significant factor for patient survival in this cohort.
Conclusions:
- Polymyxin B hemoperfusion (PMX) offered some benefits for peritonitis septic shock patients, particularly in hemodynamic status improvement.
- The study supports findings of improved survival with PMX as adjunctive therapy, though not statistically significant.
- Limited sample size and patient comorbidities may have impacted the statistical significance of PMX efficacy.
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