Direct hemoperfusion using a polymyxin B-immobilized polystyrene column for COVID-19

Area of Science:

• Critical care medicine
• Infectious diseases
• Biomedical engineering

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes pneumonia with significant morbidity and mortality.
• Existing treatments for severe COVID-19 pneumonia have limitations.
• Polymyxin B-immobilized polystyrene (PMX-DHP) is an extracorporeal treatment aimed at removing inflammatory mediators.

Purpose of the Study:

• To evaluate the efficacy and safety of PMX-DHP in patients with SARS-CoV-2-positive pneumonia.
• To assess the impact of PMX-DHP on gas exchange, inflammatory markers, and clinical outcomes.
• To identify potential complications associated with PMX-DHP treatment.

Main Methods:

• A case series of twelve SARS-CoV-2-positive pneumonia patients with a P/F ratio < 300.
• Patients received PMX-DHP on two consecutive days.
• Efficacy was assessed by P/F ratio, urinary biomarkers, disease severity, and cytokine levels at specified time points.
• Safety was evaluated by monitoring circuit malfunctions, particularly membrane coagulation.

Main Results:

• Disease severity decreased in 58.3% of patients by day 14 post-treatment.
• P/F ratio improved, and urinary β2-microglobulin levels decreased on days 4 and 8.
• Levels of interleukin-6 and vascular endothelial growth factor were reduced post-PMX-DHP.
• Circuit problems, including increased inlet pressure and membrane coagulation, occurred in some treatments, often associated with high D-dimer and fibrin degradation products.

Conclusions:

• PMX-DHP demonstrated potential benefits in improving oxygenation and reducing inflammatory markers in severe COVID-19 pneumonia.
• The risk of circuit coagulation necessitates pre-treatment assessment of coagulation capacity.
• Further clinical trials are required to establish the definitive therapeutic role of PMX-DHP in COVID-19 management.