Abstract
Direct haemoperfusion with polymyxin B-immobilized fibre (PMX-F) is a promising treatment for Gram-negative sepsis in critically ill patients. Indeed, it has been used routinely in Japan for a decade. Recent evidence presented in this journal suggests that PMX-F can have a positive impact on outcome in patients with sepsis, although other reports in the literature have presented confusing or even conflicting results. This commentary considers whether the available evidence allows us to establish an appropriate role for PMX-F treatment in sepsis and what further work is needed.
Highlights
A few years ago a new device for extracorporeal removal of circulating endotoxin entered the market (Toraymixin; Toray Industries, Osaka, Japan)
The device is intended to be used as an adjuvant therapy, adsorbing endotoxin and other products and possibly improving the altered immunohomeostasis characteristic of Gram-negative sepsis in critically ill patients
Polymyxin B-immobilized fibre (PMX-F) has been used routinely in Japan since 1995, and more than 50,000 septic patients have been treated. Is it possible to determine a clear role of polymyxin B-immobilized fibre (PMX-F) treatment in the therapy of sepsis? What work has been done far, and what must be added to the research agenda if we are to complete our evaluation?
Summary
A few years ago a new device for extracorporeal removal of circulating endotoxin entered the market (Toraymixin; Toray Industries, Osaka, Japan). The device is intended to be used as an adjuvant therapy, adsorbing endotoxin and other products and possibly improving the altered immunohomeostasis characteristic of Gram-negative sepsis in critically ill patients. Is it possible to determine a clear role of PMX-F treatment in the therapy of sepsis?
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