Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation.
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.
Kushi
Hidehiko
H
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
Miki
Takahiro
T
Okamaoto
Kazuhiko
K
Nakahara
Jun
J
Saito
Takeshi
T
Tanjoh
Katsuhisa
K
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
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016209:Interleukin-8; D017395:Plasminogen Activator Inhibitor 1; D019272:Leukocyte Elastase; D011112:Polymyxin B; D010100:Oxygen