Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 14 , ISSUE 1 ( January, 2010 ) > List of Articles

RESEARCH ARTICLE

Effectiveness of early start of direct hemoperfusion with polymyxin B-immobilized fiber columns judging from stabilization in circulatory dynamics in surgical treatment patients

Yuichiro Sakamoto, Kunihiro Mashiko, Toru Obata, Hisashi Matsumoto, Yoshiaki Hara, Noriyoshi Kutsukata, Hiroyuki Yokota

Keywords : Early goal directed therapy, polymyxin B-immobilized fiber column (PMX), septic shock

Citation Information : Sakamoto Y, Mashiko K, Obata T, Matsumoto H, Hara Y, Kutsukata N, Yokota H. Effectiveness of early start of direct hemoperfusion with polymyxin B-immobilized fiber columns judging from stabilization in circulatory dynamics in surgical treatment patients. Indian J Crit Care Med 2010; 14 (1):35-39.

DOI: 10.4103/0972-5229.63032

License: CC BY-ND 3.0

Published Online: 01-03-2012

Copyright Statement:  Copyright © 2010; The Author(s).


Abstract

Background: Septic shock remains a major cause of multiple organ failure and is associated with a high mortality rate. In 1994, direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan and has since been used for the treatment of septic shock arising from endotoxemia. Materials and Method: We treated 36 patients with septic shock using direct hemoperfusion with PMX. The patients were analyzed in two groups based on whether they had undergone surgery prior to DHP-PMX treatment (surgical group: surgical treatment before DHP-PMX, medical group: no surgical treatment). In surgical group, DHP-PMX was started within three hours after the surgical treatment. Various factors were measured before and after DHP-PMX. Results: The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27.4 ± 8.8, and the mean sepsis-related organ failure assessment (SOFA) score was 11.8 ± 4.9 before DHP-PMX. The SOFA score was significantly higher (P = 0.0091) and the PaO2/FiO2 ratio (P/F ratio) was significantly lower (P = 0.0037) in medical group than in surgical group prior to DHP-PMX. A chi-square test showed that the survival rate in surgical group was significantly better than in medical group (P = 0.0027). The survival rate of surgical group (84.2%) was judged to be very good because the predicated survival rate based on the APACHE II score (25.0) was only 46.5%. On the other hand, the survival rate of medical group (35.3%) was almost equal to that predicted by the APACHE II score (30.6; predicted survival rate, 27.4%). Conclusion: The results of this study suggest the utility of early DHP-PMX in surgical group.


PDF Share
  1. Angus D, Wax RS. Epidemiology of sepsis: An update. Crit Care Med 2001;29:S109-16.
  2. Sato T, Shoji H, Koga N. Endotoxin adsorption by polymyxin B immobilized fiber column in patients with systemic inflammatory response syndrome: The Japan experience. Ther Apher Dial 2003;7:252-8.
  3. Cruz DN, Perazella MA, Bellomo R, de Cal M, Polanco N, Corradi V, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: A systematic review. Crit Care 2007;11:R47.
  4. Tani T, Hanasawa K, Kodama M, Imaizumi H, Yonekawa M, Saito M, et al. Correlation between plasma endotoxin, plasma cytokines, and plasminogen activator inhibitor-1 in septic patients. World J Surg 2001;25:660-8.
  5. Sakamoto Y, Mashiko K, Matsumoto H, Hara Y, Kutsukata N, Yamamoto Y. Relationship between effect of polymyxin B-immobilized fiber and high mobility group box-1 protein in septic shock patients. ASAIO J 2007;53:324-8.
  6. Sakamoto Y, Mashiko K, Matsumoto H, Hara Y, Kutsukata N, Takei K, et al. Effect of direct hemoperfusion with a polymyxin B immobilized fiber column on high mobility group box-1 (HMGB-1) in severe septic shock: Report of a Case. ASAIO J 2006;52:37-9.
  7. Sakamoto Y, Mashiko K, Obata T, Matsumoto H, Hara Y, Kutsukata N, et al. Clinical responses and improvement of some laboratory parameters following polymyxin B-immobilized fiber treatment in septic shock. ASAIO J 2007;53:646-50.
  8. Cruz DN, Bellomo R, Ronco C. Clinical effects of polymyxin B-immobilized fiber column in septic patients. Contrib Nephrol 2007;156:444-51.
  9. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE: Acute physiology and chronic health evaluation: A physiological based classification system. Crit Care Med 1981;9:571-9.
  10. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure: On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Int Care Med 1996;22:707-10.
  11. Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA, et al. A pilot-controlled study of a polymyxin b-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock 2005;23:400-5.
  12. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296-327.
  13. Sakamoto Y, Mashiko K, Obata T, Matsumoto H, Hara Y, Kutsukata N, et al. Relationship between treatment resistance cases using polymyxin B-immobilized fiber and oxidative stress. ASAIO J 2008;54:412-5.
  14. Cruz DN, Antonelli M, Fumagalli, Foltran F, Brienza N, Donati A, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA 2009;301:2445-52.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.