Effectiveness of continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter after polymyxin B-immobilized fiber column therapy of septic shock.
Septic shock is a condition associated with diffuse coagulopathy and multiple organ failure, and frequently ends in death. Direct hemoperfusion using a polymyxin B-immobilized fiber column (DHP-PMX) was first developed in Japan in 1994 and has since been used for the treatment of septic shock. On the other hand, the effectiveness of continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA- CHDF) for critically ill patients has also been reported. We treated 27 septic shock patients by DHP-PMX. The patients, except for the nine in whom CHDF was not performed after DHP-PMX, were divided into two groups: namely, a group in which PMMA-CHDF therapy was added after DHP-PMX (11 cases), and a group in which continuous hemodiafiltration using a polyacrylonitrile membrane hemofilter (PAN-CHDF) therapy was added after DHP-PMX (7 cases). The outcomes in the two groups were compared. The average Acute Physiology and Chronic Health Evaluation (APACHE) II score and the average sepsis-related organ failure assessment (SOFA) score were not significantly different between the two groups. The PMMA-CHDF group showed significantly better outcomes, with significant improvements of the serum PAI-1, protein C, IL-6 and N-arachidonoylethanolamine (AEA) levels. We conclude that PMMA-CHDF may be more effective than PAN-CHDF in the management of septic shock.
Sakamoto
Yuichiro
Y
Department of Emergency and Critical Care Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
Mashiko
Kunihiro
K
Obata
Toru
T
Matsumoto
Hisashi
H
Hara
Yoshiaki
Y
Kutsukata
Noriyoshi
N
Yamamoto
Yasuhiro
Y
D000180:Acrylic Resins / Q000737:chemistry; D000328:Adult; D000368:Aged; D001095:Arachidonic Acids / Q000737:chemistry; D016207:Cytokines / Q000378:metabolism; D063388:Endocannabinoids; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000737:chemistry*; D011112:Polymyxin B / Q000737:chemistry* / Q000627:therapeutic use; D053284:Polyunsaturated Alkamides / Q000737:chemistry; D012772:Shock, Septic / Q000628:therapy*; D016896:Treatment Outcome
D000180:Acrylic Resins; D001095:Arachidonic Acids; D016207:Cytokines; D063388:Endocannabinoids; D008567:Membranes, Artificial; D053284:Polyunsaturated Alkamides; C010504:polyacrylonitrile; D019904:Polymethyl Methacrylate; D011112:Polymyxin B; C078814:anandamide