Volume 4 Supplement 1
Efficacy of the endotoxin absorption method (PMX) in patients with septic shock associated with intraperitoneal infections
© Current Science Ltd 2000
Published: 21 March 2000
Many points remain to be clarified concerning the mechanism of the endotoxin absorption method (PMX). In the present study, we investigated the efficacy of PMX in 13 patients who met all of the following four conditions: (1) patients in septic shock associated with an intraperitoneal infection; (2) patients who underwent SIRS; (3) patients with endotoxin (ET) levels of at least 10 pg/ml at the start of PMX; and (4) patients with circulatory dynamics requiring administration of catecholamine. The 13 patients consisted of nine men and four women with an average age of 62±10 years. The outcome after four weeks was survival of nine patients and death of four patients. PMX was performed for 2 h and nafamosat mesylate was used as anticoagulant. The ET value, blood pressure, WBC, pH, PaO2/FiO2,amount of DOA used, IL-6, IL-1ra, NOx, PAI-1, thrombomodulin (TM), ICAM-1 and ELAM-1 were measured immediately before, immediately after and 24 h after PMX.
The ET value showed a definite decrease from 29.7±23.4 to 14.9±11.2 pg/ml. The mean blood pressure increased from 79.7±13.8 to 97.4±16.8 torr. Among the cytokines, no significant differences were observed in IL-6 before and after PMX but IL-1ra tended to decrease. PAI-1 also decreased after PMX in the same way as IL-1ra. NOx, ICAM-1, ELAM-1 and TM showed no changes.
The inhibition of excessive increases in anti-inflammatory cytokines by PMX was considered beneficial for the body's defense from the standpoint of preventing progression to CARS.