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Polymyxin B Hemoperfusion for Patients With Septic Shock Requiring High-Dose Norepinephrine: A Multicenter
Yu Kawazoe1, Kyohei Miyamoto2, Noriko Miyagawa3
1Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Japan.
Critical Care Explorations
|September 22, 2025
Summary
Polymyxin B hemoperfusion (PMX-HP) did not improve 28-day mortality in septic shock patients. However, PMX-HP did increase mean arterial pressure and reduce vasopressor use in the initial hours of admission.
Area of Science:
- Critical Care Medicine
- Nephrology
- Immunology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Polymyxin B hemoperfusion (PMX-HP) is an extracorporeal treatment aimed at removing endotoxins during sepsis.
- The clinical efficacy of PMX-HP in sepsis remains incompletely understood.
Purpose of the Study:
- To investigate the association between PMX-HP and clinical outcomes in intensive care unit (ICU) patients with septic shock.
- To evaluate the impact of PMX-HP on mortality, hemodynamic parameters, and vasopressor requirements.
Main Methods:
- A multicenter prospective cohort study involving 20 ICUs in Japan (2020-2022).
- Included patients with septic shock requiring high-dose norepinephrine (≥ 0.2 µg/kg/min).
- Compared outcomes between patients receiving PMX-HP and those not receiving it, focusing on 28-day mortality, hemodynamic changes, and vasopressor use.
Main Results:
- Of 309 patients, 82 received PMX-HP. Baseline characteristics were similar between groups.
- No significant difference in 28-day mortality (17.1% vs. 18.9%, p=0.71) or 90-day mortality (23.5% vs. 27.1%, p=0.62).
- PMX-HP group showed higher mean arterial pressure and reduced vasopressor use from 8 to 32 hours post-admission, but had fewer ICU-free days.
Conclusions:
- PMX-HP was not associated with improved 28-day mortality in this septic shock cohort.
- PMX-HP demonstrated a transient benefit in hemodynamic support, increasing MAP and decreasing vasopressor needs.
- Careful consideration and adaptation of PMX-HP therapy are suggested based on these findings.
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