title: Endotoxin Elimination in Patients with Septic Shock: An Observation Study.
abstract: To evaluate the effectiveness of endotoxin elimination with an adsorption column in patients with septic shock and endotoxemia. The elimination therapy was guided by a new bedside method of measuring endotoxin activity (EA). Intensive care unit (ICU) patients with septic shock and suspected Gram-negative infection were consecutively added to the study group within the first 24 h. Endotoxin elimination was performed using hemoperfusion with the Alteco LPS Adsorber. The primary endpoint was improvement in organ function within the first 24 h of treatment. A secondary objective was to assess the usefulness of a new method of measuring EA to help guide endotoxin elimination therapy. Out of 64 patients 18 had a high baseline EA [0.70 EA units (0.66-0.77)]. Those patients had endotoxin elimination treatment in addition to conventional medical therapy. At 24 h after endotoxin elimination, the EA had decreased to 0.56 EA units (0.43-0.77), (p = 0.005); MAP increased from 69 (62-80) to 80 mm Hg (68-88), (p = 0.002), and noradrenaline use decreased from 0.28 (0.15-0.80) to 0.1 μg/kg/min (0.00-0.70) at the same time (p = 0.04). The SOFA score had decreased from 11 (9-15) to 9 (7-14) points 24 h after endotoxin elimination (p = 0.01) with a median delta SOFA -2 points. Endotoxin elimination did not have a significant effect on the ICU length of stay or ICU mortality. Effective endotoxin elimination resulted in a significant improvement in hemodynamic parameters and of organ function. The application of the EA assay was useful for the bedside monitoring of endotoxemia in critically ill ICU patients.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland. barbara.adamik@umed.wroc.pl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Adamik
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Zielinski
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Smiechowicz
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kübler
mesh_terms: D000327:Adsorption; D000328:Adult; D000368:Aged; D018450:Disease Progression; D004731:Endotoxins / Q000378:metabolism*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000628:therapy*; D006439:Hemodynamics; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000209:etiology / Q000517:prevention & control*
chemical_list: D004731:Endotoxins
keywords: Endotoxin elimination; Gram-negative infection; LPS measurement; Septic shock