Newly Developed Immobilized Polymyxin B Fibers Improve the Survival of Patients with Sepsis

Abstract

Background: Sepsis and septic shock are still major causes of morbidity and mortality in spite of the availability of powerful and broadly active antibiotics. Methods: A prospective, open and randomized trial of the effect of immobilized polymyxin fibers (PMX-F) on the survival of patients with sepsis throughout a follow-up period of 28 days or until discharge, if earlier, was carried out. Ninety-eight patients were included who met at least 4 of the criteria for systemic inflammatory response syndrome due to infection. The patients were classified into three groups based on their Acute Physiology and Chronic Health Evaluation (APACHE) II score. Results: The overall survival rate was significantly improved by using PMX-F compared to the control group (41 vs. 11%) (p = 0.002). In patients with an APACHE II score less than 20, treatment with PMX-F was shown to improve outcome (65 vs. 19%) (p = 0.01). In cases of more severe sepsis with an APACHE II score of 20–29, PMX-F still maintained efficacy in improving outcome (40 vs. 11%) (p = 0.04). However, PMX-F treatment did not improve the survival rate in patients with an APACHE II score of greater than 30 (survival rate 7 vs. 0%) (p = 0.59). Conclusion: From these results, it is concluded that treatment with PMX-F in patients with sepsis is effective and prolongs the survival rate when applied at an early stage of sepsis. However, in severe sepsis, this therapy does not improve the survival rate.

Direct Hemoperfusion Using Polymyxin-B Immobilized Fiber for Septic Shock After Cardiac Surgery

“…8 PMX-DHP decreases the blood levels of cytokines and improves hemodynamics, 9 so PMX-DHP not only removes endotoxin, but also other cytokines and thus improves the hemodynamics of patients with septic shock. There are many reports of improved clinical symptoms and outcome achieved by PMX-DHP therapy in the septicemic patient, 10 but without clear evidence of its efficacy. A recent pilot study showed that PMX-DHP improved the left ventricular stroke work index, 11 providing further evidence that PMX-DHP improves the hemodynamics of patients in septic shock.…”

Rapidly Progressive Interstitial Pneumonia Associated with Clinically Amyopathic Dermatomyositis Successfully Treated with Polymyxin B-immobilized Fiber Column Hemoperfusion

“…In an animal model of sepsis, PMX improves oxygenation through the suppression of nitric oxide production (21). Kushi (26). A recent paper has suggested that more frequent applications will be effective against severe sepsis (27).…”

Beneficial Effect of Polymyxin B-immobilized Fiber Column (PMX) Hemoperfusion Treatment on Acute Exacerbation of Idiopathic Pulmonary Fibrosis

“…Mortality of these patients with acute exacerbation has been reported to be high during their hospitalization (4)(5)(6). (9)(10)(11) (8,9,13 i g u r e 1 . S e r i a l Aa DO2 a n d s e r u m L DH v a l u e s p r e -a n d p o s t -P MX t r e a t me n t ( c a s e s 1 -6 ) .…”