title: Effectiveness of early start of direct hemoperfusion with polymyxin B-immobilized fiber columns judging from stabilization in circulatory dynamics in surgical treatment patients.
abstract: BACKGROUND
  Septic shock remains a major cause of multiple organ failure and is associated with a high mortality rate. In 1994, direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan and has since been used for the treatment of septic shock arising from endotoxemia.
  
  
  METHODS
  We treated 36 patients with septic shock using direct hemoperfusion with PMX. The patients were analyzed in two groups based on whether they had undergone surgery prior to DHP-PMX treatment (surgical group: surgical treatment before DHP-PMX, medical group: no surgical treatment). In surgical group, DHP-PMX was started within three hours after the surgical treatment. Various factors were measured before and after DHP-PMX.
  
  
  RESULTS
  The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27.4 +/- 8.8, and the mean sepsis-related organ failure assessment (SOFA) score was 11.8 +/- 4.9 before DHP-PMX. The SOFA score was significantly higher (P = 0.0091) and the PaO2/FiO2 ratio (P/F ratio) was significantly lower (P = 0.0037) in medical group than in surgical group prior to DHP-PMX. A chi-square test showed that the survival rate in surgical group was significantly better than in medical group (P = 0.0027). The survival rate of surgical group (84.2%) was judged to be very good because the predicated survival rate based on the APACHE II score (25.0) was only 46.5%. On the other hand, the survival rate of medical group (35.3%) was almost equal to that predicted by the APACHE II score (30.6; predicted survival rate, 27.4%).
  
  
  CONCLUSIONS
  The results of this study suggest the utility of early DHP-PMX in surgical group.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba-Hokusoh Hospital, Nippon Medical School, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Mashiko
authors.forename: Toru
authors.initials: T
authors.lastname: Obata
authors.forename: Hisashi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hara
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kutsukata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota