Polymyxin B-immobilized fiber hemoperfusion after emergency surgery in patients with chronic renal failure.
The purpose of this study was to evaluate the effect of direct hemoperfusion using a Polymyxin B (PMX) immobilized fiber column in septic patients with chronic renal failure after emergency surgery. Twenty-four renal failure patients, including 19 dialysis patients, with sepsis or septic shock were treated with direct hemoperfusion after emergency surgery. The 24 consecutive patients included nine with necrotic enterocolitis, six with colonic perforation due to diverticulitis, three with ruptured suture after colectomy, one with duodenal perforation, four with blood access infection, and one with an infected abdominal aortic aneurysm. The acute physiology and chronic health evaluation II score ranged from 13 to 26 (19 +/- 3). After completion of the first and the second hemoperfusion, mean blood pressure was significantly elevated from 69 +/- 12 mm Hg to 89 +/- 15 mm Hg and from 78 +/- 14 mm Hg to 95 +/- 13 mm Hg, respectively (P < 0.01). In addition, the catecholamine dosage needed to maintain the circulation could be decreased markedly after the treatment. The blood concentration of endotoxin in patients with Gram-negative sepsis, before and after the treatment, significantly decreased from 36 +/- 19 pg/mL to 19 +/- 19 pg/mL (P < 0.05). PMX was effective in patients with Gram-positive sepsis as well as Gram-negative sepsis. The 28-day mortality rate in patients who had emergency abdominal surgery was 10% (2/20), whereas that in patients with dialysis access infection was 50% (2/4). There was a significant difference in the Sequential Organ Failure Assessment (SOFA) score of all patients before and after treatment using PMX (9.2 +/- 3.3 vs. 7.5 +/- 3.5, P < 0.05). Furthermore, the SOFA score of survivors decreased significantly after PMX treatment (8.4 +/- 3.5 vs. 6.7 +/- 2.6, P < 0.01). Our results suggest that the early application of PMX may prevent multiple organ failure and improve survival in patients with chronic renal failure and sepsis/septic shock after emergency abdominal surgery, regardless of the type of pathogenic bacteria involved.
Department of Surgery III, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan. ttojin@kc.twmu.ac.jp
Tamotsu
T
Tojimbara
Sumihiko
S
Sato
Ichiro
I
Nakajima
Shohei
S
Fuchinoue
Takashi
T
Akiba
Satoshi
S
Teraoka
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004638:Emergency Treatment; D005260:Female; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000517:prevention & control; D010100:Oxygen / Q000097:blood; D010538:Peritonitis / Q000601:surgery; D011112:Polymyxin B; D011183:Postoperative Complications / Q000628:therapy*; D017582:Renal Replacement Therapy; D012772:Shock, Septic / Q000628:therapy*
D000900:Anti-Bacterial Agents; D011112:Polymyxin B; D010100:Oxygen