title: A longer duration of polymyxin B-immobilized fiber column hemoperfusion improves pulmonary oxygenation in patients with septic shock.
abstract: Endotoxin plays an important role in the pathogenesis of septic shock. Exposure of endothelial cells to endotoxin activates endothelial cells and increases the surface expression of adhesion molecules, markers of endothelial damage in organ dysfunction. Endotoxin adsorption therapy by polymyxin B-immobilized fiber column (PMX) hemoperfusion has been used for the treatment of septic shock patients. In this study, we measured plasma concentrations of endotoxin and soluble adhesion molecules in septic shock patients before and after the PMX treatment then observed on the relationships between actual duration of use and various outcomes. Sixteen patients with septic shock were studied. The 28-day mortality rate was 50%. The elevated plasma concentrations of endotoxin decreased after the PMX treatment in the survivors but not in the nonsurvivors. The norepinephrine dose and plasma concentrations of soluble endothelial leukocyte adhesion molecule 1 and soluble intercellular adhesion molecule 1 significantly (P < 0.05) decreased in the PMX greater-than-2-h (prolonged) group than in the PMX 2-h (conventional) group (-17.8 +/- 14.6 vs. -1.8 +/- 2.7 microg/min, -143.0 +/- 111.0 vs. 0 +/- 2.8 ng/mL, and -126.2 +/- 144.9 vs. 16.5 +/- 108.1 ng/mL, respectively). Changes in the PaO2-FiO2 ratio and the Sequential Organ Failure Assessment score were significantly (P < 0.05) more improved in the PMX greater-than-2-h group than in the PMX 2-h group (75.4 +/- 80.7 vs. 1.2 +/- 49.2 and -0.8 +/- 1.8 vs. 2.2 +/- 1.9 torr, respectively). We thus suggest that a longer duration of PMX treatment may improve the pulmonary oxygenation associated with decreased adhesion molecules in septic shock.
authors.affiliation: Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Bunkyo-ku, Tokyo, Japan. c.mitaka.icu@tmd.ac.jp
authors.forename: Chieko
authors.initials: C
authors.lastname: Mitaka
authors.forename: Naoki
authors.initials: N
authors.lastname: Tsuchida
authors.forename: Kenrou
authors.initials: K
authors.lastname: Kawada
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Takasuke
authors.initials: T
authors.lastname: Imai
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019040:E-Selectin / Q000097:blood; D004731:Endotoxins / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006464:Hemoperfusion; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D012772:Shock, Septic / Q000097:blood / Q000401:mortality / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D019040:E-Selectin; D004731:Endotoxins; D018799:Intercellular Adhesion Molecule-1; D011112:Polymyxin B