EVERE SEPSIS AND SEPTIC SHOCK AREcommon problems in the intensive care unit (ICU) and carry a high mortality. Endotoxin, one of the principal components on the outer membrane of gram-negative bacteria, is considered relevant to their pathogenesis. High levels of endotoxin activity are associated with worse clinical outcomes. 1 However, effectiveness of endotoxintargeted therapy is still controversial. 2,3 Polymyxin B, an antibiotic with high affinity for endotoxin, has been bound and immobilized to polystyrene fibers in a medical device for hemoperfusion. This device can effectively bind endotoxin both in vitro and in vivo and could potentially interrupt the biological cascade of sepsis. 4 In a systematic review, 5 direct hemoperfusion with the See also p 2496 and Patient Page.

Intraabdominal hypertension on admission was associated with severe organ dysfunction during the intensive care unit stay. The mean intraabdominal pressure on admission was not an independent risk factor for mortality; however, the occurrence of intraabdominal hypertension during the intensive care unit stay was an independent outcome predictor.

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.

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.

In critically ill patients, a continuous infusion of fenoldopam at 0.1 microg/kg/min does not cause any clinically significant hemodynamic impairment and improves renal function compared with renal dose dopamine. In the setting of acute early renal dysfunction, before severe renal failure has occurred, the attempt to reverse renal hypoperfusion with fenoldopam is more effective than with low-dose dopamine.

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