Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients.

Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients. Contrib Nephrol. 2018;196:215-222 Authors: Yamashita C, Moriyama K, Hasegawa D, Hara Y, Kuriyama N, Nakamura T, Shibata J, Komura H, Nishida O Abstract BACKGROUND: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale observational studies and meta-analyses have also been reported in the last several years. SUMMARY: To date, 3 multicenter RCTs on PMX hemoperfusion have been conducted outside of Japan. All of them enrolled postoperative patients with sepsis or septic shock secondary to intra-abdominal infection. However, confidence in the level of evidence provided by these RCTs is very low. Results from recent propensity-matched analyses and meta-analyses indicate that PMX hemoperfusion may improve survival outcomes among patients with sepsis. LPS is an important causative PAMP in sepsis; it triggers the immune response. PMX adsorbs LPS by using a polymyxin B-immobilized fiber tha...
Source: Contributions to Nephrology - Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research