Effects of endotoxin elimination therapy using polymyxin B immobilized fiber in patients with septic shock after surgical operation

Introduction

Polymyxin B immobilized fiber (PMX-20R: Toray Industries, Inc) has been developed in Japan for direct removal of endotoxin. Hanasawa et al [1] reported the use of a PMX-20R column for treating endotoxemia in animal and clinical studies. Polymyxin B was chemically fixed onto polystyrene fiber to remove endotoxin by direct hemoperfusion. We used PMX-20R to treat septic shock patients who had developed complicated multiple organ failure.

Purpose

To assess the changes in hemodynamics and cytokine levels (IL-6, TNF) during hemoperfusion with PMX-20R in treating nine septic shock patients (2 females, 7 males, mean age: 60 years old) after surgical operation.

Methods

A double-lmuen catheter was inserted into the patient's femoral vein, and direct hemoperfusion was performed using a blood pump to remove endotoxins. The blood access for hemoperfusion consisted of a venous-to-venous system. Extracorporeal circulation was performed for 120 min wilh blood flow of 80-120 ml/min.

Results

Six (67%) of nine septic shock patients who had developed complicated multiple organ failure after surgical operation survived after using PMX-20R. The mean APACHE-2 score of the patients was 27 ± 9. During hemoperfusion, the patient's vital signs were stable. Mean arterial blood pressure in fair prognosis patients increased significantly compared with control values, while slight decreases occurred in leukocyte and platelet counts after 30 min of this treatment. The values of toxicolar and endospecy (Limulus colorimetric assay) greatly declined in fair prognosis patients. IL-6 and TNF levels in fair prognosis patients had declined at 24 h post PMX. On the other hand, the values in poor prognosis did not decline.

Conclusions

Hemoperfusion with PMX-20R may be a useful therapeutic strategy in patients with septic shock. This treatment should be considered for use in patients with suspected Gram-negative rod infections after receiving surgical operation.