Criteria for direct hemoperfusion with an immobilized polymyxin B fiber column based on oxygen metabolism.
The optimum time for commencement of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) in patients with sepsis remains unclear. We retrospectively studied the response to DHP-PMX in relation to parameters of oxygen metabolism in 48 patients with sepsis who were divided into two groups. In the effective group (N = 36), the mean blood pressure increased by at least 10 mm Hg after DHP-PMX. Patients who did not show such a blood pressure elevation were assigned to the non-effective group (N = 12). Before the start of therapy, various parameters (mixed venous oxygen saturation, oxygen delivery index, oxygen consumption index (VO(2)I), oxygen extraction ratio, gastric mucosal-arterial PCO(2) difference, age, systemic vascular resistance index, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score were measured in both groups. These parameters were then compared between the two groups. Only VO(2)I showed a significant difference between the two groups, and all patients in the effective group had a VO(2)I of 100 mL/min/m(2) or more. Based on these results, DHP-PMX should be introduced during the period when VO(2)I is still equal to or greater than 100 mL/min/m(2).
Kushi
Hidehiko
H
Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan. hkushi@med.nihon-u.ac.jp
Miki
Takahiro
T
Sakagami
Yuichiro
Y
Saito
Takeshi
T
Tanjoh
Katsuhisa
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001794:Blood Pressure; D005260:Female; D016905:Gram-Negative Bacterial Infections; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011112:Polymyxin B / Q000008:administration & dosage*; D012189:Retrospective Studies; D018805:Sepsis; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000628:therapy*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D011112:Polymyxin B