title: Intraoperative direct hemoperfusion with a polymyxin-B immobilized fiber column for treatment of infective endocarditis.
abstract: OBJECTIVE
  Endotoxin adsorption treatment (direct hemoperfusion using a polymyxin-B immobilized fiber column, or PMX-DHP) is now considered a useful option for treating severe sepsis. However, the efficacy of PMX-DHP for infective endocarditis (IE), in which the causative microorganisms are usually gram-positive cocci, remains unclear. In the present study, we investigated the impact of intraoperative PMX-DHP on clinical parameters during the treatment of IE.
  
  
  METHODS
  From November 2006 to December 2009, a total of 11 patients with active IE underwent emergent surgery using intraoperative PMX-DHP. The perioperative courses of these patients were compared with those of seven patients who underwent emergent surgery for active IE with the conventional method from January 2003 to October 2006.
  
  
  RESULTS
  PMX-DHP was associated with a significant decrease in the postoperative catecholamine dose and duration. Intubation time and intensive care unit length of stay for the PMX-DHP group was significantly shorter than that for the conventional therapy group. There was also a significant difference in the number of failed organs postoperatively between the two groups.
  
  
  CONCLUSIONS
  Intraoperative PMX-DHP demonstrated several positive effects, such as a drastic decrease in the doses of inotropic agents and shortening of the duration of mechanical ventilation, in patients who underwent emergent surgery for active IE. Intraoperative PMX-DHP can be a useful option for the treatment of critically ill patients with IE.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-1-10 Marunouchi, Okayama 700-0823, Japan. toshinoritotsugawa@mac.com
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kuinose
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Tsushima
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Ishida
authors.forename: Genta
authors.initials: G
authors.lastname: Chikazawa
authors.forename: Keijiro
authors.initials: K
authors.lastname: Katayama
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002395:Catecholamines / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003422:Critical Care; D016638:Critical Illness; D004696:Endocarditis / Q000097:blood / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006464:Hemoperfusion / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D004731:Endotoxins; D011112:Polymyxin B