title: Polymyxin B-immobilized fiber column hemoperfusion removes endotoxin throughout a 24-hour treatment period.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the extent of endotoxin adsorption by polymyxin B-immobilized fiber column hemoperfusion (PMX) performed for a 24-hour treatment period in patients with septic shock.
  
  
  METHODS
  Nineteen patients with septic shock were retrospectively studied. The plasma endotoxin concentrations of blood drawn from the radial artery and from the outlet circuit of the PMX column were measured by kinetic turbidimetric limulus assay using an MT-358 Toxinometer (Wako Pure Chemical Industries, Ltd, Osaka, Japan) after 24 hours of PMX treatment. The endotoxin removal rate was defined by the following equation: ([radial artery endotoxin concentration - outlet circuit of PMX column endotoxin concentration]/radial artery endotoxin concentration) × 100%.
  
  
  RESULTS
  The patients had a median Acute Physiology and Chronic Health Evaluation II score of 29 at intensive care unit admission and a 28-day mortality of 47%. Before the start of the PMX treatment, the median radial arterial plasma endotoxin concentration was 16.48 pg/mL. After 24 hours of PMX treatment, the median radial plasma endotoxin concentration had decreased to 1.857 pg/mL, and the concentration at the outlet circuit of the PMX column was further decreased to 0.779 pg/mL. The median endotoxin removal rate was 74.4%.
  
  
  CONCLUSIONS
  These findings suggest that 24-hour PMX treatment was effective in removing endotoxin continuously throughout the entire treatment period.
authors.affiliation: Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan; Intensive Care Unit, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan. Electronic address: c.mitaka.icu@tmd.ac.jp.
authors.forename: Chieko
authors.initials: C
authors.lastname: Mitaka
authors.affiliation: Intensive Care Unit, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Fujiwara
authors.affiliation: Intensive Care Unit, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Critical Care Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyofuku
authors.affiliation: Intensive Care Unit, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Haraguchi
authors.affiliation: Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
mesh_terms: D018806:APACHE; D000327:Adsorption; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004731:Endotoxins / Q000097:blood / Q000302:isolation & purification*; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B; D017534:Radial Artery; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D016060:Sorption Detoxification / Q000379:methods*; D013997:Time Factors
chemical_list: D004731:Endotoxins; D011112:Polymyxin B
keywords: Endotoxin; Polymyxin B-immobilized fiber column hemoperfusion; Septic shock