Association of type II secretory phospholipase A2and surfactant protein D with the pulmonary oxygenation potential in patients with septic shock during polymyxin-B immobilized fiber-direct hemoperfusion.
This study was undertaken to analyze the association of type II secretory phospholipase A2(sPLA2-II) and surfactant protein D (SP-D) with the pulmonary oxygenation potential in patients with septic shock during polymyxin-B immobilized fiber-direct hemoperfusion (PMX-DHP). The study was conducted in 25 patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). PMX-DHP lowered the blood endotoxin level in all patients. Following PMX-DHP, there were decreases from day 0 → day 1 → day 2 in both the mean plasma sPLA2-II level (340 → 260 → 189 ng/mL) and plasma SP-D level (483 → 363 → 252 ng/mL). The PaO2/FiO2 ratio (P/F ratio) rose (210 → 237 → 262) in all patients. Upon the onset of ALI or ARDS, there was a significant negative correlation between the sPLA2-II level and the P/F ratio. Furthermore, there was a significant positive correlation between the sPLA2-II and TNF-α levels. The results suggest that as the blood endotoxin levels were lowered by the PMX-DHP, the inflammatory reactions were suppressed, with suppressed formation of sPLA2-II and improved pulmonary oxygenation potential. The results also suggested possible involvement of TNF-α in the production of sPLA2-II.
Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.|Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan.
Yoriko
Y
Ishibe
Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.|Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan.
Shigehiro
S
Shibata
Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.|Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan.
Gaku
G
Takahashi
Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.|Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan.
Yasushi
Y
Suzuki
Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.|Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan.
Yoshihiro
Y
Inoue
Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.|Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan.
Shigeatsu
S
Endo
D055371:Acute Lung Injury / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D004731:Endotoxins / Q000097:blood; D005260:Female; D054501:Group II Phospholipases A2 / Q000097:blood*; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000502:physiology; D011112:Polymyxin B; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood*; D012123:Pulmonary Ventilation; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D004731:Endotoxins; D037663:Pulmonary Surfactant-Associated Protein D; D014409:Tumor Necrosis Factor-alpha; D054501:Group II Phospholipases A2; D011112:Polymyxin B; D010100:Oxygen
acute respiratory distress syndrome (ARDS); blood purification; sepsis