Abstract
BackgroundEndotoxins can induce an excessive inflammatory response and result in microcirculatory dysfunction. Polymyxin-B hemoperfusion (PMX-HP) has been recognized to effectively remove endotoxins in patients with sepsis and septic shock, and a rat sepsis model revealed that PMX-HP treatment can maintain a better microcirculation. The primary aim of this study was to investigate the effect of PMX-HP on microcirculation in patients with septic shock.MethodsPatients with septic shock were enrolled and randomized to control and PMX-HP groups. In the PMX-HP group, patients received the first session of PMX-HP in addition to conventional septic shock management within 24 h after the onset of septic shock; the second session of PMX-HP was provided after another 24 h as needed.ResultsOverall, 28 patients finished the trial and were analyzed. The mean arterial pressure and norepinephrine infusion dose did not differ significantly between the control and PMX-HP groups after PMX-HP treatment. At 48 h after enrollment, total vessel density (TVD) and perfused vessel density (PVD) were higher in the PMX-HP group than in the control group [TVD 24.2 (22.1–24.9) vs. 21.1 (19.9–22.9) mm/mm2; p = 0.007; PVD 22.9 (20.9–24.9) vs. 20.0 (18.9–21.6) mm/mm2, p = 0.008].ConclusionsThis preliminary study observed that PMX-HP treatment improved microcirculation but not clinical outcomes in patients with septic shock at a low risk of mortality. Nevertheless, larger multicenter trials are needed to confirm the effect of PMX-HP treatment on microcirculation in patients with septic shock at intermediate- and high-risk of mortality.Trial registration ClinicalTrials.gov protocol registration ID: NCT01756755. Date of registration: December 27, 2012. First enrollment: October 6, 2013. https://clinicaltrials.gov/ct2/show/NCT01756755
Highlights
Endotoxins can induce an excessive inflammatory response and result in microcirculatory dysfunction
Exclusion criteria were age less than 20 years, the onset of sepsis and septic shock more than 24 h at enrollment, pregnancy, participation in interventional trials at other intensive care units (ICUs) within 30 days before enrollment, undergoing organ transplant surgery within 1 year before enrollment, life-expectancy less than 30 days, history of cardiopulmonary resuscitation (CPR) within 30 days before enrollment, signed no-CPR consent before enrollment, hemophilia, allergic history to polymyxin B or heparin, uncontrolled bleeding within 24 h before enrollment, renal replacement therapy before enrollment, white blood cells count less than 0.5 K/uL or platelet count less than 50 K/uL, human immunodeficiency virus infection, Acute Physiology and Chronic Health Evaluation (APACHE) II score higher than 30 at enrollment, and non-native speakers
The question addressed by the present study was whether polymyxin-B hemoperfusion (PMX-HP) treatment can improve microcirculation by removing endotoxin and reducing endotoxin-related microcirculatory dysfunction in patients with septic shock
Summary
The primary aim of this study was to investigate the effect of PMX-HP on microcirculation in patients with septic shock. The primary aim of this study was to investigate the effects of PMX-HP on microcirculation in patients with septic shock
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