Pan-peritonitis due to intestinal perforation, and efficacy of direct hemoperfusion with polymyxin B immobilized fiber (PMX-20R)

We used PMX-20R in the treatment of 20 septic shock patients who developed complicated multiple organ failure caused by intestinal perforation. Extracorporeal circulation was performed for 120 min with blood flow of 80–120 ml/min. In this treatment, we assessed the changes of the patient's hemodynamics and the levels of cytokine levels (TNF-α, IL-6, IL-1ra and IL-10), soluble ICAM-1, thrombomodurin, NOx and PAI-1 during and after hemoperfusion using PMX-20R. Before the treatment, the mean APACHE-2 score of the 20 patients was 24.3, mean septic severity score was 46.9, and Goris score was 4.7. Mean arterial BP and LVSWI after the treatment increased significantly compared to the values in similar patients who did not receive this treatment, while our patients showed slight decrease in platelet counts. The values of the endospecy test (the new PCA method) apparently declined at the end of PMX treatment. The two inflammatory cytokines, TNF-α and IL-6, and the anti-inflammatory cytokines, IL-1ra and IL-10, decreased immediately after PMX and at 24 h after completing PMX. On the other hand, the levels of ICAM-1, thrombomodurin, NOx did not decline. PAI-1 decreased remarkably at the end of PMX treatment and 24 h after PMX. As a result, 15 of the 20 patients had good prognosis and 5 had a poor prognosis. Therefore, hemoperfusion with PMX-20R could be a useful therapeutic measure for patients with septic shock caused by intestinal perforation, and it is recommended that this treatment shold be begun as quickly as possible after emergency surgical treatment.