Increase in systolic blood pressure and improvement in laboratory parameters following polymyxin B-immobilized fiber treatment in septic shock

Introduction

Direct hemoperfusion using a polymyxin B-immobilized fiber column (DHP-PMX; Toray Industries Inc., Tokyo, Japan) was first developed in 1994 and has since been used for the treatment of septic shock.

Methods

A total of 47 patients with septic shock who received DHP-PMX for 2 to 6 hours were retrospectively reviewed to examine any improvement in sepsis-related factors after DHP-PMX and to analyze the relationship between any such improvement and increase in SBP. In addition, we analyzed the effectiveness of long-term DHP-PMX (5 to 6 hours) with respect to improvement in sepsis-related factors.

Results

N-arachidonoylethanolamine (AEA), 2-arachidonoyl glycerol (2-AG), and plasminogen activator inhibitor-1 (PAI-1) were significantly improved after DHP-PMX treatment. SBP increased significantly in the group showing improved high mobility group box protein 1 (HMGB-1) level (P < 0.0122). AEA, 2-AG and HMGB-1 were improved in all four patients who were treated with long-term DHP-PMX.

Conclusions

We observed a relationship between hemodynamic improvement and a decrease in serum HMGB-1 level in septic shock patients treated with DHP-PMX. We suggest that long-term DHP-PMX improves sepsis-related factors.

Figure 1

Changes in systolic blood pressure in patients treated with DHP-PMX in whom HMBG-1 level increased. P < 0.0001.