Observational study for direct hemoperfusion therapy with polymyxin-B immobilized fibers (PMX-DHP) in patients with septic shock in Japan: PMX-DHP study group

Introduction

Direct hemoperfusion therapy with polymyxin-B immobilized fibers (PMX-DHP) has been widely applied as the therapeutic method for the patients with septic shock in Japan since 1994. Optimal usage of PMX-DHP for the patients with septic shock remains a matter of debate, mainly because of a lack of adequately designed clinical trials.

Methods

The observational study, carried out in 21 hospitals in Japan, was designed to investigate the effects of PMX-DHP for patients with septic shock. A total of 36 patients with septic shock were enrolled between April 2004 and January 2005.

Results

Forty-four percent (16/36) was acute peritonitis, which required laparotomy and lavage of the peritoneum before PMX-DHP. The other 56% (20/36) was unable to remove the site of infection, such as urinary tract infection, respiratory infection and unknown cause of infections. Inhospital death rates were 6% (1/16) in patients with acute peritonitis and 55% (11/20) in those without acute peritonitis (P = 0.0446). The early indication rates of PMX-DHP, within 24 hours since the onset of septic shock, were 61% (22/36). Among those 22 patients, the rate of achieving mean arterial pressure more than 65 mmHg within 6 hours of the onset of septic shock was 63% (14/22), and 18% (4/22) achieved 65 mmHg within 24 hours.

Conclusion

In this group of septic patients, the better survival rates of patients with acute peritonitis were associated with PMX-DHP. Early induction of PMX-DHP also contributed to recovering adequate arterial blood pressure.