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Context: Polymyxin B fiber column is a medical device designed to reduce blood endotoxin levels in sepsis. Gram-negative-induced abdominal sepsis is likely associated with high circulating endotoxin. Reducing circulating endotoxin levels with polymyxin B hemoperfusion could potentially improve patient clinical outcomes.Objective: To determine whether polymyxin B hemoperfusion added to conventional medical therapy improves clinical outcomes (mean arterial pressure [MAP], vasopressor requirement, oxygenation, organ dysfunction) and mortality compared with conventional therapy alone.Design, Setting, and Patients: A prospective, multicenter, randomized controlled trial (Early Use of Polymyxin B Hemoperfusion in Abdominal Sepsis [EUPHAS]) conducted at 10 Italian tertiary care intensive care units between December 2004 and December 2007. Sixty-four patients were enrolled with severe sepsis or septic shock who underwent emergency surgery for intra-abdominal infection.Intervention: Patients were randomized to either conventional therapy (n=30) or conventional therapy plus 2 sessions of polymyxin B hemoperfusion (n=34).Main Outcome Measures: Primary outcome was change in MAP and vasopressor requirement, and secondary outcomes were PaO(2)/FIO(2) (fraction of inspired oxygen) ratio, change in organ dysfunction measured using Sequential Organ Failure Assessment (SOFA) scores, and 28-day mortality.Results: MAP increased (76 to 84 mm Hg; P = .001) and vasopressor requirement decreased (inotropic score, 29.9 to 6.8; P < .001) at 72 hours in the polymyxin B group but not in the conventional therapy group (MAP, 74 to 77 mm Hg; P = .37; inotropic score, 28.6 to 22.4; P = .14). The PaO(2)/FIO(2) ratio increased slightly (235 to 264; P = .049) in the polymyxin B group but not in the conventional therapy group (217 to 228; P = .79). SOFA scores improved in the polymyxin B group but not in the conventional therapy group (change in SOFA, -3.4 vs -0.1; P < .001), and 28-day mortality was 32% (11/34 patients) in the polymyxin B group and 53% (16/30 patients) in the conventional therapy group (unadjusted hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.20-0.94; adjusted HR, 0.36; 95% CI, 0.16-0.80).Conclusion: In this preliminary study, polymyxin B hemoperfusion added to conventional therapy significantly improved hemodynamics and organ dysfunction and reduced 28-day mortality in a targeted population with severe sepsis and/or septic shock from intra-abdominal gram-negative infections.Trial Registration: clinicaltrials.gov Identifier: NCT00629382. [ABSTRACT FROM AUTHOR]

The article discusses a preliminary study which investigated the early use of polymyxin B hemoperfusion in abdominal septic shock. A prospective, multicenter, randomized controlled trial was conducted at 10 Italian tertiary care intensive care units between December 2004 and December 2007, which involved sixty-four patients with severe sepsis or septic shock who have undergone emergency surgery for intra-abdominal infection. It was found that hemodynamics and organ dysfunction were addressed by the addition of polymyxin B hemoperfusion into conventional therapy.

Objective: To investigate the relationship between intra-abdominal hypertension (IAH) and acute renal failure (ARF) in critically ill patients.Design and Setting: Prospective, observational study in a general intensive care unit.Patients: Patients consecutively admitted for >24 h during a 6-month period.Interventions: None.Measurements and Results: Intra-abdominal pressure (IAP) was measured through the urinary bladder pressure measurement method. The IAH was defined as a IAP > or =12 mmHg in at least two consecutive measurements performed at 24-h intervals. The ARF was defined as the failure class of the RIFLE classification. Of 123 patients, 37 (30.1%) developed IAH. Twenty-three patients developed ARF (with an overall incidence of 19%), 16 (43.2%) in IAH and 7 (8.1%) in non-IAH group (p<0.05). Shock (p<0.001), IAH (p=0.002) and low abdominal perfusion pressure (APP; p=0.046) resulted as the best predictive factors for ARF. The optimum cut-off point of IAP for ARF development was 12 mmHg, with a sensitivity of 91.3% and a specificity of 67%. The best cut-off values of APP and filtration gradient (FG) for ARF development were 52 and 38 mmHg, respectively. Age(p=0.002), cumulative fluid balance (p=0.002) and shock (p=0.006) were independent predictive factors of IAH. Raw hospital mortality rate was significantly higher in patients with IAH; however, risk-adjusted and O/E ratio mortality rates were not different between groups.Conclusions: In critically ill patients IAH is an independent predictive factor of ARF at IAP levels as low as 12 mmHg, although the contribution of impaired systemic haemodynamics should also be considered. [ABSTRACT FROM AUTHOR]

To investigate the relationship between intra-abdominal hypertension (IAH) and acute renal failure (ARF) in critically ill patients. Prospective, observational study in a general intensive care unit. Patients consecutively admitted for > 24 h during a 6-month period. None. Intra-abdominal pressure (IAP) was measured through the urinary bladder pressure measurement method. The IAH was defined as a IAP ≥12 mmHg in at least two consecutive measurements performed at 24-h intervals. The ARF was defined as the failure class of the RIFLE classification. Of 123 patients, 37 (30.1%) developed IAH. Twenty-three patients developed ARF (with an overall incidence of 19%), 16 (43.2%) in IAH and 7 (8.1%) in non-IAH group ( p < 0.05). Shock ( p < 0.001), IAH ( p = 0.002) and low abdominal perfusion pressure (APP; p = 0.046) resulted as the best predictive factors for ARF. The optimum cut-off point of IAP for ARF development was 12 mmHg, with a sensitivity of 91.3% and a specificity of 67%. The best cut-off values of APP and filtration gradient (FG) for ARF development were 52 and 38 mmHg, respectively. Age( p = 0.002), cumulative fluid balance ( p = 0.002) and shock ( p = 0.006) were independent predictive factors of IAH. Raw hospital mortality rate was significantly higher in patients with IAH; however, risk-adjusted and O/E ratio mortality rates were not different between groups. In critically ill patients IAH is an independent predictive factor of ARF at IAP levels as low as 12 mmHg, although the contribution of impaired systemic haemodynamics should also be considered. [ABSTRACT FROM AUTHOR]

Objective: Although intra-abdominal hypertension (IAH) can cause dysfunction of several organs and raise mortality, little information is available on the incidence and risk factors for IAH in critically ill patients. This study assessed the prevalence of IAH and its risk factors in a mixed population of intensive care patients.Design: A multicentre, prospective 1-day point-prevalence epidemiological study conducted in 13 ICUs of six countries.Interventions: None.Patients: Ninety-seven patients admitted for more than 24 h to one of the ICUs during the 1-day study period.Methods: Intra-abdominal pressure (IAP) was measured four times (every 6 h) by the bladder pressure method. Data included the demographics, medical or surgical type of admission, SOFA score, etiological factors such as abdominal surgery, haemoperitoneum, abdominal infection, massive fluid resuscitation, and ileus and predisposing conditions such as hypothermia, acidosis, polytransfusion, coagulopathy, sepsis, liver dysfunction, pneumonia and bacteraemia.Results: We enrolled 97 patients, mean age 64+/-15 years, 57 (59%) medical and 40 (41%) surgical admission, SOFA score of 6.5+/-4.0. Mean IAP was 9.8+/-4.7 mmHg. The prevalence of IAH (defined as IAP 12 mmHg or more) was 50.5 and 8.2% had abdominal compartment syndrome (defined as IAP 20 mmHg or more). The only risk factor significantly associated with IAH was the body mass index, while massive fluid resuscitation, renal and coagulation impairment were at limit of significance.Conclusion: Although we found a quite high prevalence of IAH, no risk factors were reliably associated with IAH; consequently, to get valid information about IAH, IAP needs to be measured. [ABSTRACT FROM AUTHOR]