Effects of Hemoperfusion With a Polymyxin B Membrane in Peritonitis With Septic Shock

Overview

The purpose of this randomized, comparative, open and multi-centre study is to show that two sessions of hemoperfusion with Toraymyxin performed within maximum 36 hours after the surgery of a peritonitis by hollow organ perforation reduce the mortality in patients suffering from septic shock.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: April 2013

Detailed Description

The mortality rate due to peritonitis associated to a severe sepsis or a septic shock remains high (between 40 and 60% as per the studies). The recent complementary therapies for severe sepsis have been reassessed (strict glycaemic control, substitutive corticotherapy, activated protein C). Early neutralisation of the endotoxaemia related to gram-negative bacilli sepsis in contact with hemoperfusion membrane covered with polymyxin B (Toraymyxin™) may enable reduction of the inflammatory reaction caused by sepsis and improve its prognosis. 30 studies, including 10 randomized studies, have compared hemoperfusion with Toraymyxin™ to the standard treatment, showing an improvement in the patients' haemodynamic state, oxygenation conditions and reduction in mortality. This treatment is commonly used in Japan. However, the studies conducted either include only a limited number of patients or are not randomized prospective studies. The post-hoc analysis of a recent randomized study conducted on a limited number of patients with abdominal septic shock shows a significant reduction in mortality after factor adjustment. Though the side effects of such a treatment are limited, its cost is high. Hence, extensive prospective studies are necessary to confirm its effectiveness.

Interventions

  • Device: standard therapy
    • Standard therapy in the ICU including but not limited to: antibiotic therapy, nutrition, fluid challenge, vasopressors, hemodynamic monitoring, organ support in the ICU including mechanical ventilation, renal replacement therapy when appropriate
  • Device: hemoperfusion
    • Extracorporeal hemoperfusion with Toraymyxin PMX-20R and conventional medical therapy in the ICU including but not limited to: antibiotic therapy, nutrition, fluid challenge, vasopressors, hemodynamic monitoring, organ support in the ICU including mechanical ventilation, renal replacement therapy when appropriate.

Arms, Groups and Cohorts

  • Other: Standard therapy
    • Standard therapy in the ICU including but not limited to: antibiotic therapy, nutrition, fluid challenge, vasopressors, hemodynamic monitoring, organ support in the ICU including mechanical ventilation, renal replacement therapy when appropriate
  • Experimental: Hemoperfusion
    • standard therapy + 2 sessions of hemoperfusion within the first 24 hours

Clinical Trial Outcome Measures

Primary Measures

  • Mortality
    • Time Frame: 28 days

Secondary Measures

  • organ failure assessed by SOFA score
    • Time Frame: day 3
  • delay to withdraw catecholamine after initial shock
    • Time Frame: day 1-day 28
  • mortality between the two groups at 7 dayx, 14 days, 21 days and 90 days
    • Time Frame: 90 days
  • number of participants with adverse events related to hemoperfusion technique including anticoagulation therapy such as bleeding (type and number of blood transfusion)
    • Time Frame: day1-day4

Participating in This Clinical Trial

Inclusion Criteria

  • Confirmed community or nosocomial acquired peritonitis due to organ perforation – Septic shock requiring catecholamine infusion started or maintained 2 hours after surgery Exclusion Criteria:

  • Pregnancy – No severity criteria within the 8 hours following surgery – Neutropenia due to chemotherapy or malignancy – Abdominal sepsis without peritonitis – Mesenteric ischemia without perforation – Peritonitis due to appendicitis – Perforation linked to trauma – Cirrhosis child C – Impossibility to use heparin – Prolonged cardiac arrest within 72h before surgery – Terminal disease diagnosed during surgery – Moribund subjects

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Meditor SAS
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Didier Payen, MD, Principal Investigator, Lariboisière University Hospital
    • René Robert, MD, Principal Investigator, Poitiers University Hospital

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