2017 Volume 8 Issue 2 Pages 113-117
In the management of sepsis, supportive therapy to attenuate overwhelming systemic expression of mediators is important, as well as source control. Although several randomized controlled trials (RCTs) and propensity score matching analysis of endotoxin adsorption therapy (PMX-DHP) for sepsis have been conducted, its clinical benefits in terms of mortality or long term outcome are still controversial. However, prognostic improvement has been suggested when using PMX-DHP for the severely ill population. In addition to the main mechanism of endotoxin removal, which triggers the mediator cascade, the PMX column adsorbs endogenous cannabinoids, activated neutrophils, and HLA-DR-negative monocytes. Recently, PMX-DHP was reported to possibly protect against acute kidney injury by preventing renal tubular cell apoptosis. Furthermore, PMX-DHP may continue to improve hemodynamics and pulmonary oxygenation in patients with septic shock for more than 2 hours. We believe that with proper severe-patient selection and proper duration of perfusion, PMX-DHP can improve survival in patients with sepsis or septic shock.
