Aim: To evaluate the safety and effectiveness of combined extracorporeal therapy in patients with severe sepsis after cardiac surgery. Materials and Methods: Twenty patients received combined extracorporeal therapy (LPS-adsorption with Toraymyxin columns + CPFA). The inclusion criteria were clinical signs of severe sepsis, EAA = 0.6, and PCT >2 ng/ml. 20 comparable patients in the control group received only standard therapy. Results: Each patient in the study group received 2 daily treatments of combined extracorporeal therapy. In contrast to controls, we noted an increase in the values of MAP from 73 to 82 mm Hg, (p < 0.001) and the mean oxygenation index (from 180 to 246, p < 0.001), decrease of EAA from 0.77 to 0.55, p < 0.001, and PCT (from 6.23 to 2.83 ng/ml, p < 0.001). The 28-day survival rate was 65 and 35% in the study and control groups respectively, p = 0.11. Conclusion: The combined use of LPS-adsorption and CPFA in a single circuit with standard therapy is a safe and possibly effective adjunctive method for treating severe sepsis.

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-1310.
Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-1554.
Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB: Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009. JAMA 2012;307:1405-1413.
Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM: Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc 2012;60:1070-1077.
Zimmerman JE, Kramer AA, Knaus WA: Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 2013;17:R81.
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R: Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-1316.
Oliveira DC, Oliveira Filho JB, Silva RF, Moura SS, Silva DJ, Egito ES, Martins SK, Souza LC, Jatene AD, Piegas LS: Sepsis in the postoperative period of cardiac surgery: problem description. Arq Bras Cardiol 2010;94:332-336.
Zhou F, Peng Z, Murugan R, Kellum JA: Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit Care Med 2013;41:2209-2220.
Kohn FR, Kung AH: Role of endotoxin in acute inflammation induced by gram-negative bacteria: specific inhibition of lipopolysaccharide-mediated responses with an amino-terminal fragment of bactericidal/permeability-increasing protein. Infect Immun 1995;63:333-339.
Opal SM, Esmon CT: Bench-to-bedside review: functional relationships between coagulation and the innate immune response and their respective roles in the pathogenesis of sepsis. Crit Care 2003;7:23-38.
Yaroustovsky M, Abramyan M, Popok Z, Nazarova E, Stupchenko O, Popov D, Plushch M, Samsonova N: Preliminary report regarding the use of selective sorbents in complex cardiac surgery patients with extensive sepsis and prolonged intensive care stay. Blood Purif 2009;28:227-233.
Yaroustovsky M, Abramyan M, Krotenko N, Popov D, Plyushch M, Popok Z: Endotoxin adsorption using polymyxin B immobilized fiber cartridges in severe sepsis patients following cardiac surgery. Int J Artif Organs 2014;37:299-307.
Yaroustovsky M, Abramyan M, Krotenko N, Popov D, Plyushch M, Rogalskaya E, Nazarova H: Combined extracorporeal therapy for severe sepsis in patients after cardiac surgery. Blood Purif 2014;37:39-46.
Murakami M, Miyauchi Y, Nishida M, Okada H, Hamano K: Direct hemoperfusion using polymyxin-B immobilized fiber for septic shock after cardiac surgery. Circ J 2009;73:658-661.
Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, Malcangi V, Petrini F, Volta G, Bobbio Pallavicini FM, Rottoli F, Giunta F, Ronco C: Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA 2009;301:2445-2452.
Formica M, Olivieri C, Livigni S, Cesano G, Vallero A, Maio M, Tetta C: Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock. Intensive Care Med 2003;29:703-708.
Berlot G, Agbedjro A, Tomasini A, Bianco F, Gerini U, Viviani M, Giudici F: Effects of the volume of processed plasma on the outcome, arterial pressure and blood procalcitonin levels in patients with severe sepsis and septic shock treated with coupled plasma filtration and adsorption. Blood Purif 2014;37:146-151.
Ikeda T, Ikeda K, Nagura M, Taniuchi H, Matsushita M, Kiuchi S, Kuroki Y, Suzuki K, Matsuno N: Clinical evaluation of PMX-DHP for hypercytokinemia caused by septic multiple organ failure. Ther Apher Dial 2004;8:293-298.
Kushi H, Miki T, Okamaoto K, Nakahara J, Saito T, Tanjoh K: Early hemoperfusion with an immobilized Polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit Care 2005;9:R653-R661.
Mitaka C, Tsuchida N, Kawada K, Nakajima Y, Imai T, Sasaki S: A longer duration of polymyxin B-immobilized fiber column hemoperfusion improves pulmonary oxygenation in patients with septic shock. Shock 2009;32:478-483.
Gaetano L, Capria M, Matera G, Presta P, Comi N, Talarico R, Rametti L, Quirino A, Giancotti A, Fuiano G: Coupled plasma filtration adsorption for the treatment of a patient with acute respiratory distress syndrome and acute kidney injury: a case report. NDT Plus 2011;4:285-288.
Abe S, Azuma A, Mukae H, Ogura T, Taniguchi H, Bando M, Sugiyama Y: Polymyxin B-immobilized fiber column (PMX) treatment for idiopathic pulmonary fibrosis with acute exacerbation: a multicenter retrospective analysis. Intern Med 2012;51:1487-1491.
Cruz DN, Perazella MA, Bellomo R, de Cal M, Polanco N, Corradi V, Lentini P, Nalesso F, Ueno T, Ranieri VM, Ronco C: Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care 2007;11:R47.
Marshall JC, Foster D, Vincent JL, Cook DJ, Cohen J, Dellinger RP, Opal S, Abraham E, Brett SJ, Smith T, Mehta S, Derzko A, Romaschin A; MEDIC study: Diagnostic and prognostic implications of endotoxemia in critical illness: results of the MEDIC study. J Infect Dis 2004;190:527-534.
Kojika M, Sato N, Yaegashi Y, Suzuki Y, Suzuki K, Nakae H, Endo S: Endotoxin adsorption therapy for septic shock using polymyxin B-immobilized fibers (PMX): evaluation by high-sensitivity endotoxin assay and measurement of the cytokine production capacity. Ther Apher Dial 2006;10:12-18.
Zagli G, Bonizzoli M, Spina R, Cianchi G, Pasquini A, Anichini V, Matano S, Tarantini F, Di Filippo A, Maggi E, Peris A: Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis. Minerva Anestesiol 2010;76:405-412.
Bellomo R, Tetta C, Ronco C: Coupled plasma filtration adsorption. Intensive Care Med 2003;29:1222-1228.
Mao HJ, Yu S, Yu XB, Zhang B, Zhang L, Xu XR, Wang XY, Xing CY: Effects of coupled plasma filtration adsorption on immune function of patients with multiple organ dysfunction syndrome. Int J Artif Organs 2009;32:31-38.
Turani F, Falco M, Barchetta R, Candidi F, Marinelli A, Di Corato C: Different effect of CVVHDF and coupled plasma filtration and adsorption on IL-6 and procalcitonin in sepsis. Crit Care 2011;15(suppl 1):P117.
Esteban E, Ferrer R, Alsina L, Artigas A: Immunomodulation in Sepsis: the role of endotoxin removal by polymyxin B-immobilized cartridge. Mediators Inflamm 2013;2013:507539.
Oishi K, Mimura-Kimura Y, Miyasho T, Aoe K, Ogata Y, Katayama H, Murata Y, Ueoka H, Matsumoto T, Mimura Y: Association between cytokine removal by polymyxin B hemoperfusion and improved pulmonary oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis. Cytokine 2013;61:84-89.
Hu D, Sun S, Zhu B, Mei Z, Wang L, Zhu S, Zhao W: Effects of coupled plasma filtration adsorption on septic patients with multiple organ dysfunction syndrome. Ren Fail 2012;34:834-839.
Cruz DN: Polymyxin B hemoperfusion: matching the cure to the disease. Crit Care Med 2014;42:1309-1310.
Livigni S, Bertolini G, Rossi C, Ferrari F, Giardino M, Pozzato M, Remuzzi G; GiViTI: Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (Italian Group for the Evaluation of Interventions in Intensive Care Medicine) is an independent collaboration network of Italian Intensive Care units: Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open 2014;4:e003536.
Berto P, Ronco C, Cruz D, Melotti RM, Antonelli M: Cost-effectiveness analysis of polymyxin-B immobilized fiber column and conventional medical therapy in the management of abdominal septic shock in Italy. Blood Purif 2011;32:331-340.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.