Related Experiment Videos
[Endotoxin removal in septic shock]
Kenichi Matsuda1, Hiroyuki Hirasawa, Shigeto Oda
1Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Abstract:
Endotoxin adsorption therapy with a column containing polymyxin B-immobilized fiber (PMX-DHP) has been widely applied in the treatment of endotoxin-induced septic shock in Japan. Recently, the indications for PMX-DHP have been expanded as it has become clear that anandamide can be removed from the bloodstream with PMX-DHP. On the other hand, continuous hemodiafiltration with a polymethyl methacrylate (PMMA) membrane hemofilter(PMMA-CHDF) is performed to remove various humoral mediators from the bloodstream in the ICU in many hospitals because it has been accepted that those humoral mediators play a more important role in the pathogenesis of septic shock than endotoxins. According to our own results, there were no differences in the endotoxin removal rate, anandamide removal rate, and survival rate with or without PMX-DHP during PMMA-CHDF in the treatment of patients with septic shock. These results indicate that there is no need to perform PMX-DHP for septic shock as long as PMMA-CHDF is performed, and that the indications for PMX-DHP should be circumspectly investigated again.
Insights
Polymyxin B-immobilized fiber (PMX-DHP) therapy showed no added benefit for septic shock patients undergoing polymethyl methacrylate continuous hemodiafiltration (PMMA-CHDF). Further investigation into PMX-DHP
Area of Science:
- Critical Care Medicine
- Nephrology
- Immunology
Background:
- Endotoxin adsorption therapy using polymyxin B-immobilized fiber (PMX-DHP) is a recognized treatment for endotoxin-induced septic shock.
- Recent findings suggest PMX-DHP can also remove anandamide from circulation.
- Continuous hemodiafiltration with polymethyl methacrylate (PMMA-CHDF) is utilized to clear various humoral mediators implicated in septic shock pathogenesis.
Purpose of the Study:
- To evaluate the additional benefit of PMX-DHP when used concurrently with PMMA-CHDF in treating septic shock patients.
- To compare the efficacy of PMX-DHP in removing endotoxins and anandamide during PMMA-CHDF.
- To assess the impact of combined therapies on patient survival rates.
Main Methods:
- A comparative study involving septic shock patients undergoing PMMA-CHDF.
- Inclusion of PMX-DHP as an adjunct therapy in a subset of patients.
- Measurement of endotoxin removal rates, anandamide removal rates, and survival rates.
Main Results:
- No significant difference was observed in endotoxin removal rates between patients with and without PMX-DHP during PMMA-CHDF.
- Anandamide removal rates and overall survival rates were comparable in both treatment groups.
- The addition of PMX-DHP did not provide additional benefits in the context of PMMA-CHDF for septic shock.
Conclusions:
- PMX-DHP therapy may not be necessary for septic shock patients already receiving PMMA-CHDF.
- The indications for PMX-DHP therapy warrant re-evaluation, especially when combined with PMMA-CHDF.
- Current evidence suggests PMMA-CHDF alone may be sufficient for managing septic shock, challenging the routine use of PMX-DHP.