Direct hemoperfusion using immobilized polymyxin B in patients with rapidly progressive interstitial pneumonias: a retrospective study.
BACKGROUND
Rapidly progressive interstitial pneumonia (IP), including acute exacerbation of IP, has a high mortality rate. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) was recently identified as an effective treatment for sepsis-associated acute respiratory distress syndrome. However, little is known about the effectiveness of PMX-DHP for rapidly progressive IP.


OBJECTIVE
The present study investigates whether PMX-DHP is safe and effective against rapidly progressive IP.


METHODS
We retrospectively examined the effects of PMX-DHP in 33 consecutive patients with rapidly progressive IP who were resistant to steroid pulse therapy. Patients were hospitalized at Nagasaki University Hospital between 2006 and 2009.


RESULTS
Seventy-two hours after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127-153 mm Hg) had significantly improved. One week after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127-227 mm Hg), the alveolar-arterial difference of oxygen (median 371-177 mm Hg) and the number of positive criteria for systemic inflammatory response syndrome had significantly improved, despite the ineffectiveness of corticosteroid pulse therapy. The serum level of monocyte chemotactic protein 1 was significantly decreased immediately after PMX-DHP.


CONCLUSIONS
PMX-DHP was safe and effective in improving oxygenation and systemic inflammatory response syndrome in patients with rapidly progressive IP. The beneficial effects of PMX-DHP may be at least partially due to the inhibition of monocyte activation.
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
Shintaro
S
Hara
Hiroshi
H
Ishimoto
Noriho
N
Sakamoto
Hiroshi
H
Mukae
Tomoyuki
T
Kakugawa
Yuji
Y
Ishimatsu
Mariko
M
Mine
Shigeru
S
Kohno
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018932:Chemokine CCL2 / Q000097:blood; D005260:Female; D006464:Hemoperfusion; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D011112:Polymyxin B