Treatment of septic patients with an arginine-based endotoxin adsorber column improves hemodynamics and reduces oxidative stress: results of a feasibility study.

BACKGROUND Mortality of severe sepsis and septic shock is unacceptably high. Adsorptive removal of endotoxin may interrupt the inflammatory cascade triggered by lipopolysaccharide. METHODS Prospective feasibility study with plasma separation and adsorption (PSA) treatment using a novel arginine-coated adsorber column was performed in a tertiary care gastroenterological intensive care unit. RESULTS 10 patients with severe sepsis/septic shock (median APACHE II score: 27, hospital mortality 40%) were treated with PSA on 5 consecutive days. There were no serious adverse events. No patient died during the treatment period. During treatment sessions, mean arterial pressure and cardiac power index increased while vasopressors could be reduced. Advanced oxidation protein products and in vitro pro- apoptotic activity of plasma decreased. We could not demonstrate any changes in endotoxin levels. CONCLUSIONS PSA resulted in a reduction of indicators of oxidative stress and pro-apoptotic activity of the plasma and an improvement in hemodynamic parameters, suggesting increased myocardial contractility and reduced septic vasodilation.