Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation.
OBJECTIVE
Although some studies have reported favorable effects of direct hemoperfusion with polymyxin-B-immobilized fiber columns (PMX) for the treatment of septic shock, few studies have demonstrated the efficacy of PMX in studies with a uniform case definition and without any other blood purification techniques.


METHODS
Fifty-two patients with severe sepsis or septic shock secondary to colorectal perforation were treated with PMX. Hemodynamic alterations and plasma concentrations of endotoxin, interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1Ra), IL-6, IL-8, and IL-10 were evaluated following PMX treatment.


RESULTS
We observed a significant reduction in plasma endotoxin in the nonsurvivors immediately after PMX treatment compared to before treatment. Systolic blood pressure was markedly increased and circulating levels of IL-1beta, IL-1Ra, and IL-8 were significantly reduced during a 2-h interval of PMX.


CONCLUSIONS
Our findings suggested that PMX treatment appears to adsorb endotoxin and also modulates circulating cytokine during a 2-h interval of direct hemoperfusion in septic patients with such condition.
Shimizu
Tomoharu
T
Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
Hanasawa
Kazuyoshi
K
Sato
Koichi
K
Umeki
Masahiko
M
Koga
Nobuhiko
N
Naganuma
Tatsushi
T
Sato
Seiji
S
Shimonishi
Tomonori
T
Ikeda
Toshiaki
T
Matsuno
Naoto
N
Ono
Satoshi
S
Saitoh
Hitoshi
H
Satoh
Koshi
K
Otani
Yoshimasa
Y
Endo
Yoshihiro
Y
Eguchi
Yutaka
Y
Tani
Tohru
T
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D003108:Colonic Diseases / Q000276:immunology / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D004731:Endotoxins / Q000097:blood; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000276:immunology / Q000628:therapy*; D018836:Inflammation Mediators / Q000097:blood*; D007416:Intestinal Perforation / Q000276:immunology / Q000601:surgery*; D008297:Male; D011112:Polymyxin B / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000276:immunology / Q000601:surgery*; D018805:Sepsis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D016207:Cytokines; D004731:Endotoxins; D018836:Inflammation Mediators; D011112:Polymyxin B