title: Early induction of PMX-DHP improves oxygenation in severe sepsis patients with acute lung injury.
abstract: Direct hemoperfusion with polymyxin B-immobilized fibers (PMX-DHP) has been widely regarded as a treatment modality for septic shock in Japan. Recently, it was reported that PMX significantly improved the P/F (PaO2/FiO2) ratio in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The aim of this study was to examine whether the phase of sepsis is related to the effects of PMX-DHP treatment on oxygenation in patients with ALI and ARDS. Thirty-four patients who had ALI or ARDS with severe sepsis were included in this study, and split into two groups: a high-risk for septic shock (H-R) group and a septic shock (S-S) group, based on the cut-off value at a mean arterial pressure of 60 mmHg. We analyzed the modified APACHE-II score, the sepsis-related organ failure assessment (SOFA) score, mean blood pressure (mBP), catecholamine index (CAI), P/F ratio, and 28 days mortality before and after PMX-DHP treatment. SOFA and modified APACHE-II scores showed no significant difference between the two groups. In both groups, mBP and CAI increased significantly following PMX-DHP. In the H-R group, P/F ratio increased from 194 +/- 83 to 262 +/- 113 after PMX-DHP treatment, with a statistical significance, whereas no difference was found in the S-S group. There was no difference in the 28 days survival rate between the groups. It was suggested that early introduction of PMX-DHP for severe sepsis may improve oxygenation.
authors.affiliation: Critical Care Medical Center, Hiroshima Prefectural Hospital, 1-5-54, Ujina-Kanda, Minami-ku, Hiroshima 734-8530, Japan. h.suyama@ccv.ne.jp
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Suyama
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kawasaki
authors.forename: Shingo
authors.initials: S
authors.lastname: Morikawa
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kaneko
authors.forename: Takao
authors.initials: T
authors.lastname: Yamanoue
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000188:drug therapy* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000502:physiology; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011112:Polymyxin B / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000378:metabolism; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D020780:Matrix Metalloproteinase 9; D011112:Polymyxin B; D010100:Oxygen