Endotoxin adsorption using polymyxin B immobilized fiber cartridges in severe sepsis patients following cardiac surgery.

Abstract

INTRODUCTION:

Sepsis still represents an obstacle in modern medicine. The purpose of this study was to evaluate the safety and effectiveness of selective lipopolysaccharide (LPS)-adsorption therapy using polymyxin B immobilized fiber cartridges in adult patients complicated with severe sepsis after cardiac surgery.

METHODS:

65 patients received extracorporeal LPS-adsorption procedures using Toraymyxin columns (PMX; Toray, Tokyo, Japan) in addition to the standard treatment according to the Surviving Sepsis Campaign guidelines. The inclusion criteria were clinical signs of severe sepsis, endotoxin activity assay (EAA)≥0.6, and blood plasma procalcitonin (PCT)>2 ng/ml. For the control group, we selected 40 patients who were comparable with the study group but who received only the standard therapy.

RESULTS:

Each patient received 2 standard LPS-adsorption procedures (lasting for 120 min each). After the LPS-adsorption course, we noted any indices of hemodynamic improvements, including an increase in mean arterial pressure from 73 to 89 mmHg (p<0.001), mean oxygenation index (213-265, p<0.001. We observed a decrease in LPS concentrations by the EAA (0.71-0.55, p<0.001) and by the LAL test (1.44-0.36 EU/ml, p<0.001). In the control group, there were no significant changes in any of the studied parameters. Moreover, the 28-day mortality was 42% in the study group and 65% in the control group (p=0.032). The endotoxin adsorption procedures were not associated with any adverse reactions, and specifically, no extracorporeal circuit thrombosis cases were noted.

CONCLUSIONS:

Selective LPS-adsorption is a safe and possibly effective adjunctive treatment method for severe sepsis patients.

• Authors: Michail Yaroustovsky, Marina Abramyan, Nickolay Krotenko, Dmitry Popov, Marina Plyushch, Zakhar Popok
• Journal: The International journal of artificial organs (Int J Artif Organs) Vol. 37 Issue 4 Pg. 299-307 (Apr 2014) ISSN: 1724-6040 [Electronic] United States
• PMID: 24811184 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Endotoxins
• Polymyxin B

Topics

• Adsorption
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Cardiac Surgical Procedures (adverse effects, mortality)
• Case-Control Studies
• Endotoxins (blood)
• Female
• Hemoperfusion (adverse effects, methods)
• Humans
• Male
• Middle Aged
• Polymyxin B (adverse effects, therapeutic use)
• Prospective Studies
• Sepsis (blood, diagnosis, microbiology, mortality, therapy)
• Time Factors
• Treatment Outcome