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Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

Jin Joo Kim1, Young Jun Park2, Ki Yoon Moon2

  • 1Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.

World Journal of Gastrointestinal Surgery
|December 28, 2019
PubMed
Abstract

Insights

Polymyxin B hemoperfusion (PMX-HP) improved organ function and reduced ICU stay in patients with gram-negative septic shock. However, PMX-HP did not significantly impact ICU mortality rates in this study.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Nephrology

Background:

  • Polymyxin B hemoperfusion (PMX-HP) is utilized to treat intra-abdominal septic shock by removing endotoxins from gram-negative bacteria.
  • Gram-negative bacilli are a common cause of severe infections, leading to sepsis and septic shock.

Purpose of the Study:

  • To evaluate the clinical effectiveness of PMX-HP in patients experiencing gram-negative septic shock post-abdominal surgery.
  • To assess the impact of PMX-HP on organ function, length of stay, and mortality in this patient population.

Main Methods:

  • A cohort of patients with septic shock secondary to peritonitis was studied between January 2012 and December 2018.
  • Patients were divided into PMX-HP treated and control groups, with 1:1 propensity score matching employed to balance baseline characteristics.
  • Clinical outcomes, including Sequential Organ Failure Assessment (SOFA) scores and intensive care unit (ICU) mortality, were compared between groups.

Main Results:

  • After propensity score matching, 40 patients (20 per group) were analyzed.
  • The PMX-HP group showed significant improvements in total SOFA, renal SOFA, and coagulation SOFA scores compared to the control group.
  • While the length of ICU stay was significantly shorter in the PMX-HP group, ICU mortality rates were similar between the groups (50% in both).

Conclusions:

  • Polymyxin B hemoperfusion (PMX-HP) is a viable adjunctive therapy for ICU patients with peritonitis, improving organ impairment and hemodynamic stability.
  • PMX-HP may enhance clinical outcomes, particularly when combined with surgical source control and conventional sepsis treatment in gram-negative infections.
Keywords:
Intraabdominal septic shockPanperitonitisPolymyxin B hemoperfusionSepsisToraymyxin

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