The wind changed direction and the big river still flows: from EUPHRATES to TIGRIS.

The overall result of the randomized controlled double-blinded trial for polymyxin B-immobilized fiber column on septic shock (EUPHRATES trial) was disappointing. However, post hoc analysis showed benefits for patients with certain Endotoxin Activity Assay (EAA) levels. Thus, the study will be repeated, and the data will be added to the former trial. Using a precision medicine approach, eligibility criteria have been modified in TIGRIS to include patients with MODS score > 9 and EAA levels between 0.60 and 0.89. We are currently feeling the change in the wind as the rivers continue to flow towards PMX therapy for endotoxemic septic shock.