title: Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial.
abstract: OBJECTIVE
  To test whether the polymyxin B hemoperfusion (PMX HP) fiber column reduces mortality and organ failure in peritonitis-induced septic shock (SS) from abdominal infections.
  
  
  METHODS
  Prospective, multicenter, randomized controlled trial in 18 French intensive care units from October 2010 to March 2013, enrolling 243 patients with SS within 12 h after emergency surgery for peritonitis related to organ perforation. The PMX HP group received conventional therapy plus two sessions of PMX HP. Primary outcome was mortality on day 28; secondary outcomes were mortality on day 90 and a reduction in the severity of organ failures based on Sequential Organ Failure Assessment (SOFA) scores.
  
  
  RESULTS
  
  
  
  METHODS
  day 28 mortality in the PMX HP group (n = 119) was 27.7 versus 19.5% in the conventional group (n = 113), p = 0.14 (OR 1.5872, 95% CI 0.8583-2.935). Secondary endpoints: mortality rate at day 90 was 33.6% in PMX-HP versus 24% in conventional groups, p = 0.10 (OR 1.6128, 95% CI 0.9067-2.8685); reduction in SOFA score from day 0 to day 7 was -5 (-11 to 6) in PMX-HP versus -5 (-11 to 9), p = 0.78. Comparable results were observed in the predefined subgroups (presence of comorbidity; adequacy of surgery, <2 sessions of hemoperfusion) and for SOFA reduction from day 0 to day 3.
  
  
  CONCLUSIONS
  This multicenter randomized controlled study demonstrated a non-significant increase in mortality and no improvement in organ failure with PMX HP treatment compared to conventional treatment of peritonitis-induced SS.
authors: Department of Anesthesia and Critical Care, SAMU, Lariboisière University Hospital, University Paris 7 Denis Diderot, Paris, France, dpayen1234@orange.fr.
authors: Didier M
authors: DM
authors: Payen
authors: Joelle
authors: J
authors: Guilhot
authors: Yoann
authors: Y
authors: Launey
authors: Anne Claire
authors: AC
authors: Lukaszewicz
authors: Mahmoud
authors: M
authors: Kaaki
authors: Benoit
authors: B
authors: Veber
authors: Julien
authors: J
authors: Pottecher
authors: Olivier
authors: O
authors: Joannes-Boyau
authors: Laurent
authors: L
authors: Martin-Lefevre
authors: Matthieu
authors: M
authors: Jabaudon
authors: Olivier
authors: O
authors: Mimoz
authors: Rémi
authors: R
authors: Coudroy
authors: Martine
authors: M
authors: Ferrandière
authors: Eric
authors: E
authors: Kipnis
authors: Carlos
authors: C
authors: Vela
authors: Stéphanie
authors: S
authors: Chevallier
authors: Jihad
authors: J
authors: Mallat
authors: René
authors: R
authors: Robert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009102:Multiple Organ Failure / Q000517:prevention & control; D010538:Peritonitis / Q000188:drug therapy* / Q000401:mortality; D011112:Polymyxin B / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B