title: Clinical Effects of a Longer Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion Therapy for Severe Sepsis and Septic Shock.
abstract: Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) therapy is widely used for the treatment of severe sepsis and septic shock, and is generally performed for 2 h. Although previous studies demonstrated the efficacy of PMX-DHP therapy, it currently remains unclear whether its optimal duration is 2 h. This retrospective study analyzed 37 patients with septic shock who showed a poor clinical response to 2 h of PMX-DHP, and underwent a longer duration of this therapy. The mean duration of PMX-DHP therapy was 15.8 ± 7.9 h, and none of the patients developed adverse events, which enabled the therapy to be performed safely. The pressure catecholamine index [CAIP = catecholamine index/mean arterial pressure; catecholamine index = dopamine + dobutamine + (adrenaline + noradrenaline) × 100 μg/kg per min], as an indicator of hemodynamics, improved significantly in the survival group in the period between the start and 24 h after the end of PMX-DHP therapy (P < 0.01), and between 2 h after the start of and the end of this therapy (P < 0.05). In addition, the P/F ratio improved significantly in the group of surviving patients with acute respiratory distress syndrome (ARDS) in the period between the start and 24 h after the end of PMX-DHP therapy (P < 0.01), and between 2 h after the start of and the end of this therapy (P < 0.01). These results suggest that a longer duration of PMX-DHP therapy can be expected to improve the hemodynamics and pulmonary oxygenation capacity of patients with severe sepsis/septic shock. Strict prospective studies are needed in the future.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Chizuru
authors.initials: C
authors.lastname: Yamashita
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Hara
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Naohide
authors.initials: N
authors.lastname: Kuriyama
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishida
mesh_terms: D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D005260:Female; D006464:Hemoperfusion / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010101:Oxygen Consumption; D011112:Polymyxin B / Q000494:pharmacology*; D011652:Pulmonary Circulation / Q000187:drug effects; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B
keywords: Direct hemoperfusion; Hemodynamics; Long duration; Polymyxin B-immobilized fiber column; Pulmonary oxygenation capacity; Septic shock