Improved outcome of septic shock patients treated without polymyxin B hemoperfusion

Abstract

Early use of polymyxin B hemoperfusion to treat septic shock patients has become widespread in Japan. However, it remains controversial whether this treatment is beneficial. Polymyxin B hemoperfusion was not performed for septic shock patients in our ICU, but rather hemodynamics were maintained with noradrenaline, a small amount of vasopressin and left ventricular preloading as appropriate based on assessment by echocardiography. We retrospectively analyzed the outcomes of 28 septic shock patients undergoing emergency laparotomy for lower intestinal diseases. The mean mortality rate was 17.9%, which was lower than the predicted mortality rate of 63.3% based on APACHE II scores. The mortality rate of 15 patients with perforation of the large intestine was 0% compared with the predicted mortality rate of 57.7%. The significantly lower mortality rate in our ICU suggests that polymyxin B hemoperfusion is not an optimal choice for first line therapy in septic shock patients.