title: The application of immobilized polymyxin B fiber in the treatment of septic shock associated with severe acute pancreatitis: report of two cases.
abstract: The elimination of endotoxin by direct hemoperfusion over immobilized polymyxin B fiber (PMX-F) was carried out in two patients who developed septic shock associated with severe acute pancreatitis. Parameters such as blood pressure, body temperature, and plasma endotoxin level improved after PMX-F treatment, and the infected lesions were successfully and safely removed by surgery. Although an aggressive operative strategy of debridement with ultimate closure over drains is generally associated with low mortality in patients with this devastating disease, we often hesitate to perform this operation due to the poor condition of the patient in the acute period, with multiple organ failure and/or septic shock status, and also because of the difficulty in diagnosing the pancreatic infection. In this situation, endotoxin elimination using PMX-F is a useful tool for treating secondary pancreatic infections to help the patient recover in preparation for surgery, or for treating perioperative endotoxemia.
authors.affiliation: First Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Asanuma
authors.forename: T
authors.initials: T
authors.lastname: Furuya
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.forename: S
authors.initials: S
authors.lastname: Shibata
authors.forename: K
authors.initials: K
authors.lastname: Koyama
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004731:Endotoxins; D017809:Fatal Outcome; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D009336:Necrosis; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011112:Polymyxin B / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004731:Endotoxins; D011112:Polymyxin B