Polymyxin Hemoperfusion Reduces Mortality Associated With Endotoxemia
Cruz DN, Antonelli M, Fumagalli R, et al.
JAMA. 2009;301:2445-2452
Can the high mortality associated with endotoxemia be reduced with hemoperfusion using an external polymyxin B-containing perfusion device? The authors performed a randomized trial in 64 surgical patients with sepsis or septic shock relating to intra-abdominal infection. Based on Acute Physiology and Chronic Health Evaluation II scores, blood pressure, and other preoperative baseline characteristics, the polymyxin perfused group and the conventional therapy group were similar, as were the microorganisms isolated from the subjects. Mortality rate after 28 days was 32% in the polymyxin B perfusion group compared with 53% in the control group; after adjusting for initial status, this difference was significant (P = .01).
Severe surgical sepsis associated with hemodynamic instability carries a high mortality. The results of this randomized trial showed a significant reduction in mortality following hemoperfusion using a polymyxin column. This small trial reflected the difficulty in patient accrual. Furthermore, because the results strongly favored treatment with polymyxin hemoperfusion, the trial was terminated prior to planned completion because of ethical considerations.
Abstract
Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock: The EUPHAS Randomized Controlled Trial
Cruz DN, Antonelli M, Fumagalli R, et al.
JAMA. 2009;301:2445-2452
Summary
Can the high mortality associated with endotoxemia be reduced with hemoperfusion using an external polymyxin B-containing perfusion device? The authors performed a randomized trial in 64 surgical patients with sepsis or septic shock relating to intra-abdominal infection. Based on Acute Physiology and Chronic Health Evaluation II scores, blood pressure, and other preoperative baseline characteristics, the polymyxin perfused group and the conventional therapy group were similar, as were the microorganisms isolated from the subjects. Mortality rate after 28 days was 32% in the polymyxin B perfusion group compared with 53% in the control group; after adjusting for initial status, this difference was significant (P = .01).
Viewpoint
Severe surgical sepsis associated with hemodynamic instability carries a high mortality. The results of this randomized trial showed a significant reduction in mortality following hemoperfusion using a polymyxin column. This small trial reflected the difficulty in patient accrual. Furthermore, because the results strongly favored treatment with polymyxin hemoperfusion, the trial was terminated prior to planned completion because of ethical considerations.
Abstract
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