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Modifications of peripheral perfusion in patients with vasopressor-dependent septic shock treated with polymyxin
Motohiro Sekino1, Yu Murakami2, Shuntaro Sato3
1Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. m-sekino@nagasaki-u.ac.jp.
Abstract:
Abnormal peripheral perfusion (PP) worsens the prognosis of patients with septic shock. Polymyxin B-direct hemoperfusion (PMX-DHP) increases blood pressure and reduces vasopressor doses. However, the modification of PP following administration of PMX-DHP in patients with vasopressor-dependent septic shock have not yet been elucidated. A retrospective exploratory observational study was conducted in patients with septic shock treated with PMX-DHP. Pulse-amplitude index (PAI), vasoactive inotropic score (VIS), and cumulative fluid balance data were extracted at PMX-DHP initiation (T0) and after 24 (T24) and 48 (T48) h. Changes in these data were analyzed in all patients and two subgroups (abnormal PP [PAI < 1] and normal PP [PAI ≥ 1]) based on the PAI at PMX-DHP initiation. Overall, 122 patients (abnormal PP group, n = 67; normal PP group, n = 55) were evaluated. Overall and in the abnormal PP group, PAI increased significantly at T24 and T48 compared with that at T0, with a significant decrease in VIS. Cumulative 24-h fluid balance after PMX-DHP initiation was significantly higher in the abnormal PP group. PMX-DHP may be an effective intervention to improve PP in patients with abnormal PP; however, caution should be exercised as fluid requirements may differ from that of patients with normal PP.
Insights
Polymyxin B-direct hemoperfusion (PMX-DHP) improved peripheral perfusion (PP) in septic shock patients with abnormal PP. However, fluid requirements were higher in this group, necessitating careful monitoring during treatment.
Area of Science:
- Critical Care Medicine
- Nephrology
- Sepsis Pathophysiology
Background:
- Abnormal peripheral perfusion (PP) is linked to poor prognosis in septic shock.
- Polymyxin B-direct hemoperfusion (PMX-DHP) is known to improve hemodynamics and reduce vasopressor needs.
- The impact of PMX-DHP on PP in vasopressor-dependent septic shock remains unclear.
Purpose of the Study:
- To investigate the modification of peripheral perfusion (PP) after Polymyxin B-direct hemoperfusion (PMX-DHP) in patients with vasopressor-dependent septic shock.
- To compare changes in PP, hemodynamic status, and fluid balance between patients with abnormal and normal PP at baseline.
Main Methods:
- A retrospective observational study analyzed 122 patients with septic shock treated with PMX-DHP.
- Data on Pulse-Amplitude Index (PAI), Vasoactive Inotropic Score (VIS), and fluid balance were collected at baseline (T0), 24 hours (T24), and 48 hours (T48).
- Patients were subgrouped based on baseline PAI (abnormal PP: PAI < 1; normal PP: PAI ≥ 1).
Main Results:
- Overall and in the abnormal PP group, PAI significantly increased at T24 and T48 compared to T0.
- A significant decrease in VIS was observed in the overall and abnormal PP groups.
- The cumulative 24-h fluid balance was significantly higher in the abnormal PP group.
Conclusions:
- PMX-DHP appears effective in improving peripheral perfusion (PP) in septic shock patients with abnormal PP.
- Clinicians should exercise caution due to potentially increased fluid requirements in patients with abnormal PP receiving PMX-DHP.
- Further research may clarify optimal fluid management strategies for this patient subgroup.
