title: Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation.
abstract: BACKGROUND
  The objective of this study was to clarify the efficacy and mechanism of action of direct hemoperfusion with an immobilized polymyxin B fiber column (DHP-PMX) in patients with acute lung injury or acute respiratory distress syndrome caused by sepsis.
  
  
  METHODS
  Thirty-six patients with sepsis were included. In each patient a thermodilution catheter was inserted, and the oxygen delivery index and oxygen consumption index were measured. DHP-PMX was performed in patients with a normal oxygen delivery index and oxygen consumption index (> 500 ml/minute per m2 and > 120 ml/minute per m2, respectively). The Acute Physiology and Chronic Health Evaluation II score was used as an index of the severity of sepsis, and survival was assessed after 1 month. The humoral mediators measured were the chemokine IL-8, plasminogen activator inhibitor-1, and neutrophil elastase (NE). These mediators were measured before DHP-PMX treatment, and at 24, 48, and 78 hours after the start of treatment. The arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was measured before DHP-PMX treatment and at 24, 48, 72, 92, and 120 hours after the start of treatment.
  
  
  RESULTS
  All patients remained alive after 1 month. Before DHP-PMX treatment, the Acute Physiology and Chronic Health Evaluation II score was 24 +/- 2.0, the IL-8 level was 54 +/- 15.8 pg/ml, plasminogen activator inhibitor-1 was 133 +/- 28.1 ng/ml, and NE was 418 +/- 72.1 mug/l. These three humoral mediators began to decrease from 24 hours after DHP-PMX treatment, and the decline became significant from 48 hours onward. The PaO2/FiO2 ratio was 244 +/- 26.3 before DHP-PMX treatment but improved significantly from 96 hours onward. There were significant negative correlations between the PaO2/FiO2 ratio and blood levels of NE and IL-8.
  
  
  CONCLUSIONS
  The mechanism of action of DHP-PMX is still not fully understood, but we report the following findings. The mean blood levels of plasminogen activator inhibitor-1, NE, and IL-8 were significantly decreased from 48 hours after DHP-PMX treatment. The mean PaO2/FiO2 ratio was significantly improved from 96 hours after DHP-PMX treatment. Improvement in the PaO2/FiO2 ratio appeared to be related to the decreases in blood NE and IL-8 levels.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Tokyo, 173-8610, Japan. hkushi@med.nihon-u.ac.jp
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kushi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Miki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Okamaoto
authors.forename: Jun
authors.initials: J
authors.lastname: Nakahara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Tanjoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D042783:Endothelial Cells / Q000378:metabolism; D005260:Female; D006464:Hemoperfusion / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011112:Polymyxin B / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000276:immunology / Q000378:metabolism / Q000628:therapy*; D018805:Sepsis / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016209:Interleukin-8; D017395:Plasminogen Activator Inhibitor 1; D019272:Leukocyte Elastase; D011112:Polymyxin B; D010100:Oxygen