More effective use of polymyxin-B hemoperfusion for nonoperation cases

Introduction

Direct hemoperfusion with polymyxin-B has been reported to improve hemodynamics in postsurgical patients. In 2012, the Japanese Guidelines for the Management of Sepsis were published and mention the efficacy of polymyxin-B direct hemoperfusion. But how to use and the target patients are varied by facilities. We investigated the effective use of polymyxin-B direct hemoperfusion in nonsurgical patients.

Methods

We analyzed retrospectively all septic shock patients who were treated with polymyxin-B hemoperfusion between January 2008 and December 2012.We checked their mean arterial pressure (MAP), and vasopressor requirement every 30 minutes until stopping treatment.

Results

There were 32 patients under treatment and 11 patients did not need surgical treatment. Even in the nonsurgical group, hemodynamic states and vasopressor requirement was improved after polymyxin-B hemoperfusion started. And the effects were continued over 120 minutes. A second plolymyxin-B hemoperfusion treatment underwent in nine patients. In second treatment, MAP increased in the nonsurgical group greater than in the postsurgical group.

Conclusion

Polymyxyn-B direct hemoperfusion improves hemodynamic status even in nonsurgical patients. A second polymyxin-B direct hemoperfusion is effective especially in nonsurgical septic shock patients. And if its hemodynamic effect was significantly, long-time treatment should be considered.