Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock

Cruz, Dinna N.; Antonelli, Massimo; Fumagalli, Roberto; Foltran, Francesca; Brienza, Nicola; Donati, Abele; Malcangi, Vincenzo; Petrini, Flavia; Volta, Giada; Pallavicini, Franco M. Bobbio; Rottoli, F.; Giunta, Francesco; Ronco, Claudio

doi:10.1001/jama.2009.856

Cited by 722 publications

(618 citation statements)

References 39 publications

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“…However, as several new RCTs274, 275, 481 to investigate the utility of blood apheresis in the treatment of sepsis in adult patients have been announced successively in Europe and the United States, assessing the significance of this intervention for pediatric patients is believed to be valuable.…”

Section: Cq19: Pediatric Considerationsmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq19: Pediatric Considerationsmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…Though still under evaluation in Europe and the US, polymyxin B hemoadsorption (Toraymyxin; Toray Industries, Inc., Tokyo, Japan) is widely used in Japan as a blood purification therapy and is covered by the Japanese national health insurance [42]. The EUPHAS (Early Use of Polymyxin B Hemoperfusion in Abdominal Sepsis) study was a prospective, multicenter randomized controlled study that was performed in 10 Italian intensive care units [43]. Sixty-four patients with severe sepsis or septic shock were randomly assigned to one of two groups (either conventional therapy or conventional therapy along with two sessions of polymyxin B hemoadsorption) within the 6 hours following emergency surgery for intra-abdominal infection.…”

Section: Hemoadsorptionmentioning

confidence: 99%

Clinical review: Blood purification for sepsis

2011

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Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.

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“…All patients enrolled in the previously published EUPHAS study had completed the two planned sessions of PMX with higher mortality observed in the control group 22. The incidence of cartridge clotting in the ABDO‐MIX study (11.4%; 25/220 sessions) was higher than in previous reports, such as 5.8% (4/68 sessions) in the EUPHAS study7 and 1.0% (12/1152 sessions) in the EUPHAS 2 study 25. Clotting problems in the blood circuit during PMX were seldom raised in Japan.…”

Section: Clinical Evidence For the Use Of Pmx In The Treatment Of Sevmentioning

confidence: 57%

“…The findings of a meta‐analysis demonstrated the favorable effects of PMX in 2007 6. The results of a subsequent RCT in Europe, the EUPHAS study (Early Use of Polymyxin B Hemoperfusion in Abdominal Sepsis), which was conducted in Italy, were published in 2009, showing that PMX results in a significant reduction in sepsis‐associated mortality 7. A large RCT, the ABDO‐MIX trial (Effects of Hemoperfusion with a Polymyxin B Membrane in Peritonitis with Septic Shock) in France, failed to show a survival benefit and improvement in organ failure with PMX compared to the conventional treatment of peritonitis‐induced septic shock 8.…”

Section: History Of the Development Of Toraymyxinmentioning

confidence: 99%

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History and current status of polymyxin B‐immobilized fiber column for treatment of severe sepsis and septic shock

Shimizu

Miyake

Tani

2017

Annals of Gastroent Surgery

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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.

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Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock

Cited by 722 publications

References 39 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Clinical review: Blood purification for sepsis

History and current status of polymyxin B‐immobilized fiber column for treatment of severe sepsis and septic shock

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