Early management of endotoxemia using the endotoxin activity assay and polymyxin B-based hemoperfusion.
BACKGROUND
We evaluated the ability of the endotoxin activity (EA) assay to determine the need for early intervention for endotoxemia using polymyxin B-based hemoperfusion (PMX-DHP) on septic patients.


METHODS
Twenty-four patients were enrolled. Eleven patients had a high EA level (> or = 0.6) and were treated with PMX-DHP every 24 h until the EA level was low ( < 0.4). The remaining 13 patients had EA levels < 0.60 and received standard therapy only.


RESULTS
Two PMX-DHP treatments were performed on 4 patients, three treatments on 6 patients and four treatments on 1 patient. After the therapy, mean arterial pressure increased (69.45 to 84.09 mm Hg; p < 0.01), heart rate decreased (Ill.73 to77.91 beats/min; p < 0.01), white blood cell count decreased (18,380 to 9,550 cells/mm(3); p < 0.01), the PMN (polymorphonuclear) percentage decreased (88.45 to 67.82%; p < 0.01) and PaO(2)/FiO(2) increased (275 to 308.09; p < 0.01). All 24 patients survived to the 28-day follow-up.


CONCLUSIONS
The EA assay can identify patients eligible for PMX-DHP treatment and aids its therapeutic dosing.
Novelli
G
G
Ferretti
G
G
Ruberto
F
F
Morabito
V
V
Pugliese
F
F
D001049:Apnea / Q000209:etiology; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D003131:Combined Modality Therapy; D019446:Endotoxemia / Q000097:blood / Q000188:drug therapy*; D004731:Endotoxins / Q000097:blood* / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000209:etiology; D005833:Genital Neoplasms, Female / Q000601:surgery; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D006339:Heart Rate / Q000187:drug effects; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D016040:Lung Transplantation / Q000009:adverse effects; D011112:Polymyxin B / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000097:blood* / Q000188:drug therapy; D017741:Survivors
D004731:Endotoxins; D002245:Carbon Dioxide; D011112:Polymyxin B