Early hemoperfusion with a polymyxin b column improves gastric intramucosal pH in sepsis

This study had two purposes. One was to assess gastric intramucosal pH (pHi) after early goal-directed therapy in patients with sepsis and septic shock. The other was to determine whether direct hemoperfusion with a polymyxin B fiber column (DHP-PMX) could improve the pHi if it remained low after early goal-directed therapy. The subjects were 32 patients who underwent early goal-directed therapy within 6 h of a diagnosis of sepsis or septic shock, and who achieved the following conditions: (i) central venous pressure of 8-12 mm Hg; (ii) mean arterial blood pressure >or=65 mm Hg; (iii) urine output >or=0.5 mL/kg/h; and (iv) mixed venous oxygen saturation >or=70%. A gastric tonometer was inserted in each patient and the pHi was measured before DHP-PMX, and at 24, 48, and 72 h after the start of treatment. The pHi was 7.22 +/- 0.04 immediately before DHP-PMX, 7.28 +/- 0.03 (P < 0.05) at 24 h, 7.32 +/- 0.03 (P < 0.01) at 48 h, and 7.34 +/- 0.02 (P < 0.01) at 72 h, showing a significant increase from 24 h onward compared with the pretreatment value. In patients with sepsis and septic shock, the pHi remained low after early goal-directed therapy; however, it was significantly improved from 24 h after the start of DHP-PMX and was normalized from 48 h onwards. These findings suggest that DHP-PMX improves pHi. Because this was a prospective uncontrolled observational study on a limited number of patients, larger multicenter clinical trials are required to more accurately assess the benefits of DHP-PMX.