Effect of direct hemoperfusion using polymyxin B immobilized fiber on inflammatory mediators in patients with severe sepsis and septic shock.
The objective of this study was to investigate retrospectively the effect of direct hemoperfusion using polymyxin B immobilized fiber (PMX-DHP) in a cartridge to remove endotoxin on inflammatory mediators in septic patients. PMX-DHP was performed 59 times in 40 patients with severe sepsis and septic shock due to gram-negative bacterial infection. Mean age and APACHE II score were 63 years and 22, respectively. The first treatments with PMX-DHP were started when patient hemodynamics were unstable even after conventional therapies. The second treatments were performed in 19 patients whose hemodynamics were still unstable after the first PMX-DHP. The changes in inflammatory mediator levels were compared from baseline to post treatment with PMX-DHP. Statistical differences were calculated using the Wilcoxon rank sum test. Plasma endotoxin could be detected in 34 patients, which was significantly decreased in 20 cases measured by a chromogenic kinetic limulus amebocyte lysate assay (p=0.0254) and in 14 cases measured by a new limulus turbidimetric time assay (p=0.0196). Monocyte counts in peripheral blood decreased significantly (p=0.0402). Interleukin-6 decreased significantly (p=0.0020). Blood pyruvate also decreased significantly (p=0.0025). At the same time, mean arterial pressure, pulse pressure, systemic vascular resistance index, and urine output were significantly increased. These results indicated that PMX-DHP could decrease inflammatory mediators and be effective to interrupt the pathogenic sequence leading to septic shock due to gram-negative bacterial infection.
Kanesaka
S
S
Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital, Yokohama - Japan. kanesaka@med.showa-u.ac.jp
Sasaki
J
J
Kuzume
M
M
Narihara
K
K
Takahashi
Y
Y
D018806:APACHE; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004731:Endotoxins / Q000097:blood; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006439:Hemodynamics; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007258:Informed Consent; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000628:therapy; D011113:Polymyxins; D018805:Sepsis / Q000097:blood / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000209:etiology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D011113:Polymyxins