Clinical evaluation of PMX-DHP for hypercytokinemia caused by septic multiple organ failure.
Endotoxin-adsorbing fibers have been applied to treat septic shock patients. The limitations of endotoxin hemoadsorption therapy (PMX-DHP) and the optimal time to start PMX-DHP were examined in patients with septic multiple organ failure with hypercytokinemia (interleukin-6 = 1000 pg/mL). Subjects were separated into those who survived more than 28 days after the start of PMX-DHP therapy (S group) and those who did not (N-S group). Severity of symptoms and background factors, blood biochemical parameters, hemodynamic parameters, PaO(2)/FiO(2), pathogens, endotoxin, cytokines, and vascular endothelial cell function-related markers were examined before and after PMX-DHP. Number of days from onset of shock (or symptom development) to PMX-DHP initiation was longer in the N-S group than in the S group. These results suggest that PMX-DHP could save more lives in patients with septic multiple organ failure with IL-6 = 1000 pg/mL when applied early after the onset of shock.
Division of Critical Care and Emergency Medicine, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan. toshi@tokyo-med.ac.jp
Toshiaki
T
Ikeda
Kazumi
K
Ikeda
Masatoshi
M
Nagura
Hitoshi
H
Taniuchi
Mikiko
M
Matsushita
Shintarou
S
Kiuchi
Yuichi
Y
Kuroki
Kaori
K
Suzuki
Naoto
N
Matsuno
D018806:APACHE; D000900:Anti-Bacterial Agents; D019040:E-Selectin / Q000097:blood; D004731:Endotoxins / Q000097:blood; D006464:Hemoperfusion; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D009102:Multiple Organ Failure / Q000150:complications / Q000628:therapy*; D011112:Polymyxin B; D012771:Shock, Hemorrhagic / Q000628:therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000628:therapy*
D000900:Anti-Bacterial Agents; D019040:E-Selectin; D004731:Endotoxins; D015850:Interleukin-6; D018799:Intercellular Adhesion Molecule-1; D011112:Polymyxin B