Abstract
Toraymyxin® (Toray Medical Co., Ltd, Tokyo, Japan) has been developed as a direct hemoperfusion column that contains polymyxin B‐immobilized fiber to bind endotoxins in patients’ blood. Toraymyxin was approved by the Japanese National Health Insurance system for the treatment of endotoxemia and septic shock in 1994. Since then, PMX (defined as direct hemoperfusion with Toraymyxin) has been safely used in more than 100 000 cases in emergency and intensive care units in Japan. Toraymyxin is currently available for use in clinical settings in 12 countries outside of Japan. We reviewed and analyzed the development, clinical use, and efficacy of Toraymyxin, and assessed the current status of Toraymyxin use for the treatment of severe sepsis and septic shock. Our review shows that PMX appeared to be effective in improving hemodynamics and respiratory function in septic shock requiring emergency abdominal surgery. Recent large‐scale ranomized controlled trialscould not demonstrate whether prognosis is improved by PMX. However, the latest meta‐analysis revealed that PMX significantly decreased mortality in patients with severe sepsis and septic shock. Combination of PMX with continuous hemodiafiltration and longer duration of PMX might be an effective strategy to improve survival in such patients.
Highlights
Despite recent advancements in surgical intervention and critical care, the prognosis of patients with endotoxemia and septic shock remains poor
A recent review has shown that co-detection of Gram-negative bacteria and endotoxemia is predictive of an increased risk of mortality compared to the detection of neither.[1]
Despite the problem of statistical analysis on mortality, the high mortality rate in the conventional treatment group and the lack of evaluation of circulating endotoxin levels, this study demonstrated improvement in hemodynamic conditions in patients with severe sepsis and septic shock as primary endpoints of an randomized controlled trial (RCT) conducted outside of Japan
Summary
Despite recent advancements in surgical intervention and critical care, the prognosis of patients with endotoxemia and septic shock remains poor. Results of the first preliminary randomized controlled trial (RCT) in Europe were published in 2005, showing that treatment with PMX was safe and improves cardiac and renal dysfunction in patients with sepsis or septic shock.[5] The findings of a meta-analysis
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