Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock: The EUPHAS Randomized Controlled Trial

CONTEXT Polymyxin B fiber column is a medical device designed to reduce blood endotoxin levels in sepsis. Gram-negative–induced abdominal sepsis is likely associated with high circulating endotoxin. Reducing circulating endotoxin levels with polymyxin B hemoperfusion could potentially improve patien...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2009-06, Vol.301 (23), p.2445-2452
Main Authors: Cruz, Dinna N, Antonelli, Massimo, Fumagalli, Roberto, Foltran, Francesca, Brienza, Nicola, Donati, Abele, Malcangi, Vincenzo, Petrini, Flavia, Volta, Giada, Bobbio Pallavicini, Franco M, Rottoli, Federica, Giunta, Francesco, Ronco, Claudio
Format: Article
Language:English
Subjects:
Abdomen
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - therapeutic use
Antibiotics
Biological and medical sciences
Digestive System Diseases - mortality
Digestive System Diseases - therapy
Emergency and intensive care: infection, septic shock
General aspects
Gram-Negative Bacterial Infections - mortality
Gram-Negative Bacterial Infections - therapy
Hemodynamics
Hemoperfusion - instrumentation
Humans
Intensive care medicine
Medical sciences
Mortality
Polymyxin B - therapeutic use
Prospective Studies
Respiratory Transport
Sepsis
Shock, Septic - mortality
Shock, Septic - physiopathology
Shock, Septic - therapy
Studies
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Summary:CONTEXT Polymyxin B fiber column is a medical device designed to reduce blood endotoxin levels in sepsis. Gram-negative–induced abdominal sepsis is likely associated with high circulating endotoxin. Reducing circulating endotoxin levels with polymyxin B hemoperfusion could potentially improve patient clinical outcomes. OBJECTIVE To determine whether polymyxin B hemoperfusion added to conventional medical therapy improves clinical outcomes (mean arterial pressure [MAP], vasopressor requirement, oxygenation, organ dysfunction) and mortality compared with conventional therapy alone. DESIGN, SETTING, AND PATIENTS A prospective, multicenter, randomized controlled trial (Early Use of Polymyxin B Hemoperfusion in Abdominal Sepsis [EUPHAS]) conducted at 10 Italian tertiary care intensive care units between December 2004 and December 2007. Sixty-four patients were enrolled with severe sepsis or septic shock who underwent emergency surgery for intra-abdominal infection. INTERVENTION Patients were randomized to either conventional therapy (n=30) or conventional therapy plus 2 sessions of polymyxin B hemoperfusion (n=34). MAIN OUTCOME MEASURES Primary outcome was change in MAP and vasopressor requirement, and secondary outcomes were PaO2/FIO2 (fraction of inspired oxygen) ratio, change in organ dysfunction measured using Sequential Organ Failure Assessment (SOFA) scores, and 28-day mortality. RESULTS MAP increased (76 to 84 mm Hg; P = .001) and vasopressor requirement decreased (inotropic score, 29.9 to 6.8; P 
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2009.856