A targeted extracorporeal therapy for endotoxemia: the time has come

Endotoxemia, whether primary ( due to Gram-negative infection) or secondary ( due to epithelial barrier dysfunction), appears to be extremely common in the critically ill and injured. High levels of endotoxin activity are associated with worse clinical outcomes. In Japan, polymyxin B hemoperfusion has been available to treat endotoxemia for more than ten years. Multiple small trials, often limited by methodological quality, show that polymyxin B hemoperfusion may have favorable effects on survival and hemodynamics. Further study of this therapy would seem justified.