{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T16:00:55Z","timestamp":1783180855103,"version":"3.54.6"},"reference-count":41,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Sepsis and septic shock (SS) represent complex, life-threatening conditions driven by a dysregulated host immune response, leading to multi-organ failure (MOF). The SEPSIS-3 guidelines have emphasized the role of immunology in defining sepsis, but therapies targeting individual mediators have largely failed. Hemoadsorption (HA), particularly with polymyxin B (PMX), presents a promising approach to modulate this immune response by non-specifically removing endotoxins and other mediators, potentially restoring physiological homeostasis. This review explores the use of PMX hemoperfusion (PMX-HA) over the last 20 years in critically ill patients, examining its role in sepsis, particularly in endotoxemic septic shock. PMX-HA works by targeting endotoxin removal, reducing inflammatory mediators, and modulating immune cell activity, including neutrophil and monocyte function. However, treatment success varies due to patient heterogeneity. Identifying optimal target populations, based on markers like endotoxin activity (EAA), SOFA scores, and lactate levels, is critical for determining the timing, dose, and duration of PMX-HA therapy. Recent studies have highlighted the importance of stratifying patients by severity and endotoxin burden, suggesting that PMX-HA is most beneficial for patients with high endotoxin activity and severe organ dysfunction. Additionally, prolonged PMX-HA sessions may improve outcomes in patients with sustained endotoxin levels. This review emphasizes the need for a personalized approach to PMX-HA, with tailored treatment protocols to optimize clinical outcomes in sepsis and septic shock patients. Future research should focus on refining patient selection criteria and determining the most effective treatment regimens.<\/jats:p>","DOI":"10.1177\/08850666251368803","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T12:53:31Z","timestamp":1756731211000},"page":"91-96","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Applications of Polymyxin B Hemadsorption in Sepsis and Septic Shock"],"prefix":"10.1177","volume":"41","author":[{"given":"Fiorenza","family":"Ferrari","sequence":"first","affiliation":[{"name":"San Bortolo Hospital"},{"name":"Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Voza","sequence":"additional","affiliation":[{"name":"Humanitas University-Research Hospital"},{"name":"Department of Biomedical Sciences, Humanitas University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Fumagalli","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Savioli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, IRCCS Polyclinic San Matteo, Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5764-6118","authenticated-orcid":false,"given":"Christian","family":"Zanza","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, Geriatric Medicine Residency Program - University of Rome \u201cTor Vergata\u201d, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Grasselli","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31829eb98f"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000533468"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22168882"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22020816"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21020379"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tibs.2016.10.004"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/imr.12292"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2174\/0929867328666210915115056"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.2194"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1159\/000515740"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.14618"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001085"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ab.2010.10.033"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae089"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13550"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/ph15121496"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002680020028"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc3815"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001340050761"},{"key":"e_1_3_3_22_2","first-page":"405","article-title":"Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis","volume":"76","author":"Zagli G","year":"2010","unstructured":"Zagli G, Bonizzoli M, Spina R, et al. 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