Early initiation of polymyxin B-immobilized fiber therapy effective for septic shock after aortic replacement

A 76-year-old female underwent ascending aorta and partial arch replacement. She developed septic shock on postoperative day 6. She was administered dopamine, 10 microg x kg(-1) x min(-1); dobutamine, 5 microg x kg(-1) x min(-1); and norepinephrine, 0.3 microg x kg(-1) x min(-1). However, the blood pressure was 74/40 mmHg. Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was started; 3 h later, the blood pressure increased to 118/54 mmHg. Norepinephrine was stopped, and dopamine and dobutamine doses were decreased to 5 microg x kg(-1) x min(-1) 3 and 12 h after completing PMX-DHP, respectively. In suspected septic shock, early PMX-DHP simultaneously with drug treatment facilitates hemodynamic improvement.