Hémoperfusion au cours du sepsis sévère

Endotoxin is an important pathogenic trigger for inflammatory response in sepsis. The possibility to antagonize endotoxin may improve the prognosis of septic shock. Polymyxin-B is known to bind to endotoxin, an outer membrane component of Gram negative bacteria but its renal and neural toxicities prevent the clinical use in human. Polymyxin-B has been coated to into polystyrene derived fibers that are packed in a cartridge that may be used during hemoperfusion. It has been demonstrated in experimental studies both in vitro and in vivo that hemoperfusion over immobilized polymyxin-B could remove endotoxin from the blood. The induced production of proinflammatory products, especially cytokines, could be in turn attenuated. Several clinical studies have been performed in patients with severe sepsis and septic shock showing an improvement of hemodynamic disorders, of oxygenation conditions and possibly of mortality. However, large study is mandatory to confirm the efficacy of this device. Other substances that may adsorb endotoxin or inflammatory products coated to different artificial cartridge are currently studied.