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Direct hemoperfusion using polymyxin-B immobilized fiber for septic shock after cardiac surgery
Masanori Murakami1, Yoshitoyo Miyauchi, Masahiko Nishida
1Department of Cardiovascular Surgery, Shakaihoken Tokuyama Central Hospital, Shunan, Japan. surg-1@yamaguchi-u.ac.jp
Background:
The factors contributing to the efficacy and outcome of direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP) after cardiac surgery were investigated.
Methods And Results:
In 23 patients who received PMX-DHP for shock related to infection after cardiac surgery, there were no differences in the pre- and intraoperative clinical data of survivors (n=14) and non-survivors (n=9). Before the PMX-DHP treatment, the clinical assessment values of the survivors and non-survivors, respectively, showed the following significant differences: sepsis-related organ failure assessment score, 9.46+/-2.84 vs 12.89+/-3.37 (P<0.05); number of failed organs, 1.8+/-0.9 vs 3.1+/-1.1 (P<0.05); partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, 194+/-118 vs 102+/-29 (P<0.05); and total bilirubin, 2.7+/-2.8 vs 8.7+/-6.5 mg/dl (P<0.05). The systolic blood pressure and catecholamine index in the survivors improved significantly 12 h after PMX-DHP treatment, from 83+/-19 mmHg to 118+/-14 mmHg (P<0.01), and from 20.7+/-11.5 to 14.9+/-8.0 (P<0.05). Conversely, in the non-survivors, only the systolic blood pressure improved significantly, from 74+/-17 mmHg to 118+/-33 mmHg (P<0.001).
Conclusions:
Prompt initiation of PMX-DHP with drug treatment during the postoperative course of patients with septic shock caused by systemic inflammatory response syndrome related to infection and who are refractory to vasopressor treatment, can improve the disease state before multiple organ failure develops.
Insights
Polymyxin-B immobilized fiber direct hemoperfusion (PMX-DHP) can improve septic shock after cardiac surgery. Early PMX-DHP treatment is crucial for better outcomes in patients with systemic inflammatory response syndrome.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Nephrology
Background:
- Investigating factors influencing the efficacy of polymyxin-B immobilized fiber direct hemoperfusion (PMX-DHP) post-cardiac surgery.
- Assessing PMX-DHP in patients with shock due to infection following cardiac procedures.
Purpose of the Study:
- To determine the clinical factors associated with survival in patients undergoing PMX-DHP for septic shock after cardiac surgery.
- To evaluate the impact of PMX-DHP on physiological parameters in this patient cohort.
Main Methods:
- Retrospective analysis of 23 patients receiving PMX-DHP for post-cardiac surgery septic shock.
- Comparison of clinical data, organ failure scores, and gas exchange parameters between survivors and non-survivors.
- Monitoring of hemodynamic parameters (systolic blood pressure, catecholamine index) before and after PMX-DHP treatment.
Main Results:
- No significant differences in pre- and intraoperative data between survivors and non-survivors.
- Survivors showed significantly lower SOFA scores, fewer organ failures, better PaO2/FiO2 ratios, and lower total bilirubin levels pre-treatment.
- PMX-DHP improved systolic blood pressure and catecholamine index in survivors, and systolic blood pressure in non-survivors within 12 hours.
Conclusions:
- Early initiation of PMX-DHP alongside drug treatment can improve the condition of patients with septic shock refractory to vasopressors.
- Timely intervention with PMX-DHP may prevent the progression to multiple organ failure in post-cardiac surgery septic shock patients.
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