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Early induction of PMX-DHP improves oxygenation in severe sepsis patients with acute lung injury

Hidemichi Suyama1, Yuko Kawasaki, Shingo Morikawa

  • 1Critical Care Medical Center, Hiroshima Prefectural Hospital, 1-5-54, Ujina-Kanda, Minami-ku, Hiroshima 734-8530, Japan. h.suyama@ccv.ne.jp

Hiroshima Journal of Medical Sciences
|March 6, 2009
PubMed

Insights

Early application of polymyxin B-immobilized fibers direct hemoperfusion (PMX-DHP) may enhance oxygenation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) patients with severe sepsis. This treatment showed significant P/F ratio improvement in high-risk septic shock patients but not in established septic shock.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Nephrology

Background:

  • Direct hemoperfusion with polymyxin B-immobilized fibers (PMX-DHP) is a recognized treatment for septic shock, particularly in Japan.
  • Recent findings suggest PMX-DHP improves the PaO2/FiO2 (P/F) ratio in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

Purpose of the Study:

  • To investigate if the phase of sepsis influences the efficacy of PMX-DHP on oxygenation in ALI/ARDS patients.
  • To compare the effects of PMX-DHP on hemodynamic parameters, oxygenation, and mortality between patients with severe sepsis at high risk for septic shock and those in established septic shock.

Main Methods:

  • A study involving 34 patients with ALI/ARDS and severe sepsis, divided into a high-risk for septic shock (H-R) group and a septic shock (S-S) group (mean arterial pressure < 60 mmHg).
  • Analysis of modified APACHE-II, SOFA scores, mean blood pressure (mBP), catecholamine index (CAI), P/F ratio, and 28-day mortality before and after PMX-DHP treatment.

Main Results:

  • Both groups showed significant improvements in mBP and CAI post-PMX-DHP treatment.
  • The H-R group experienced a statistically significant increase in the P/F ratio (194 to 262), while the S-S group did not.
  • No significant differences in modified APACHE-II or SOFA scores, or 28-day mortality, were observed between the groups.

Conclusions:

  • Early initiation of PMX-DHP in severe sepsis patients with ALI/ARDS may lead to improved oxygenation.
  • The phase of sepsis appears to be a critical factor in determining the effectiveness of PMX-DHP for improving oxygenation in ALI/ARDS patients.

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