S01E31 | Filtering Endotoxin in Septic Shock — Is Tigris a Practice Changer?

Septic shock remains one of the deadliest conditions in intensive care, with mortality near 40% and no widely adopted therapy that directly targets a defined sepsis biology. In this episode of PRISM Rounds, we break down the Tigris trial, the phase 3 randomized study of polymyxin B haemoadsorption in endotoxic septic shock, published in The Lancet Respiratory Medicine on March 23, 2026. We cover the biology of endotoxin-driven shock, the role of the Endotoxin Activity Assay (EAA), why the 0.60–0.89 range mattered so much for treatment selection, and how the investigators used a Bayesian framework informed by prior data from EUPHRATES. We then examine the results, including a 95.3% posterior probability of benefit at 28 days, 99.4% at 90 days, and an estimated number needed to treat of 6.5. Most importantly, we ask the bedside question: does this change practice now, or is it an important signal that still needs confirmation and regulatory follow-through?Full text: https://doi.org/10.1016/S2213-2600(26)00047-0ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT03901807PubMed: https://pubmed.ncbi.nlm.nih.gov/41887242/ Disclosure: Funded by Spectral Medical; conflicts are discussed in the episode. PRISM Rounds is an independent educational podcast and does not provide medical advice.#CriticalCare #Sepsis #SepticShock #IntensiveCare #ICU #PulmonaryCriticalCare #EmergencyMedicine #InternalMedicine #PrecisionMedicine #ClinicalTrials #EvidenceBasedMedicine #MedEd #FOAMed #MedicalPodcast #Healthcare #Medicine #Physician #MedStudent #ResidentLife #Nursing #RespiratoryTherapy