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Clinical effects of polymyxin B immobilised fiber with direct hemoperfusion for the patients of severe sepsis or septic shock caused by intra-abdominal infections

Introduction

The endotoxin adsorption method polymyxin B immobilised fiber with direct hemoperfusion (PMX-DHP) has been used for treatment of patients with severe sepsis and septic shock primarily caused by Gram-negative infections in Japan [1]. One hundred and twenty-six septic patients who had severe sepsis or septic shock due to intra-abdominal infections were treated with PMX-DHP.

Methods

These patients were separated into two groups: whose who survived for at least 28 days after the start of PMX-DHP therapy (survival: 85 cases) and those who did not (nonsurvival: 41 cases). Background factors and inflammatory mediators were examined in each group. PMX-DHP was assessed with the changes of clinical parameters (heart rate, systolic arterial pressure, mean arterial pressure, PaO2/FiO2) and various cytokines (TNFα IL-6, IL-8, IL-1ra, PAI-1). Sepsis was diagnosed according to the criteria of the American College of Chest Physicians/Critical Care Medicine Consensus Conference Committee.

Results

A total of 91.7% of survival cases were principally treated with surgical procedure. On demographic data, Goris's multiple organ failure score only showed significant differences between the groups (survival cases: 5.8 ± 2.8, nonsurvival cases: 8.0 ± 2.6, P < 0.05). Procalcitonin (PCT) before PMX-DHP in all patients was 59.1 ± 97.2 ng/ml and tended to decrease, 54.7 ± 81.7 ng/ml after PMX-DHP. PCT was 67.3 ± 109.6 ng/ml before PMX-DHP and significantly decreased to 54.7 ± 82.1 ng/ml immediately after PMX-DHP in the survival group, but, it did not change significantly in the nonsurvival group. There was a significant correlation between endotoxin and PCT (r = 0.527, P < 0.001).

Conclusion

Our results may suggest that PMX-DHP for the patients with severe sepsis or septic shock caused by intra-abdominal infections can improve hemodynamic changes and pulmonary oxygenation, and also reduce systemic inflammatory cytokines and serum PCT in the survival group.

References

  1. 1.

    Ikeda T, Ikeda K, Taniuchi H, et al.: Clinical evaluation of PMX-DHP for hypercytokinemia caused by septic multiple organ failure. Ther Apher Dial 2004, 8: 293-298. 10.1111/j.1526-0968.2004.00167.x

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Ikeda, T., Ikeda, K., Taniuchi, H. et al. Clinical effects of polymyxin B immobilised fiber with direct hemoperfusion for the patients of severe sepsis or septic shock caused by intra-abdominal infections. Crit Care 13, P283 (2009). https://doi.org/10.1186/cc7447

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Keywords

  • Septic Shock
  • Severe Sepsis
  • Survival Group
  • Procalcitonin
  • Survival Case