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[Endotoxin eliminating therapy in patients with severe sepsis--direct hemoperfusion using polymyxin B immobilized
1First Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Background And Methods:
PMX is a blood purifier containing chemically immobilized polymyxin B fiber (PMX-F). To evaluate its effectiveness on the severe septic human, direct hemoperfusion (DHP) using a PMX-F was performed for 2 hours. The changes in various circulatory parameters, symptoms of septic shock, and blood endotoxin concentration and the survival rate, were evaluated.
Results:
DHP was performed 61 times in 42 patients, of whom 38 had septic MOF, 25 with gram-negative bacterial infection. At the initiation of this treatment, 33 patients were receiving vasoactive agents, and 36 were under artificial ventilation via endotracheal intubation. The mean septic severity score (SSS) in all patients was about 46.6. Twenty-two of the 42 survived. The endotoxin concentration (mean +/- S.E.; pg/ml) was 85.0 +/- 27.2 immediately before treatment but significantly decreased to 57.5 +/- 28.4 after treatment (n = 50) and to 28.2 +/- 4.4 on the next day (n = 23) (p < 0.01). The endotoxin concentrations at the inlet and outlet of the PMX also significantly decreased 30 minutes after the initiation of DHP. Circulatory parameters, BP, CI, SVR and Vo2I demonstrated significant improvement. Body temperature also showed the same results. The removal of endotoxin in the blood using PMX was effective for severe sepsis or septic MOF. Various symptoms due to endotoxin was alleviated after this treatment.
Insights
Direct hemoperfusion using polymyxin B fiber (PMX-F) effectively reduced endotoxin levels in severe sepsis patients. This blood purification therapy improved circulatory parameters and alleviated septic shock symptoms, leading to better survival rates.
Area of Science:
- Critical Care Medicine
- Nephrology
- Biomedical Engineering
Background:
- Severe sepsis and septic multiple organ failure (MOF) present significant clinical challenges.
- Endotoxemia is a key factor contributing to the pathophysiology of sepsis and MOF.
- Current treatments for severe sepsis often require intensive support and may have limited efficacy.
Purpose of the Study:
- To evaluate the effectiveness of direct hemoperfusion (DHP) with polymyxin B fiber (PMX-F) in treating severe human sepsis.
- To assess the impact of PMX-F treatment on endotoxin levels, circulatory parameters, and survival rates in septic patients.
Main Methods:
- Direct hemoperfusion (DHP) using a polymyxin B fiber (PMX-F) blood purifier was performed for 2 hours.
- Evaluated changes in circulatory parameters, septic shock symptoms, blood endotoxin concentration, and survival rates.
- Analyzed data from 42 patients with severe sepsis, including those with septic MOF and gram-negative bacterial infections.
Main Results:
- PMX-F treatment significantly reduced blood endotoxin concentrations from 85.0 pg/ml to 57.5 pg/ml post-treatment and 28.2 pg/ml the next day (p < 0.01).
- Significant improvements were observed in circulatory parameters (BP, CI, SVR, Vo2I) and body temperature.
- Twenty-two out of 42 patients survived, indicating a potential benefit of PMX-F in severe sepsis management.
Conclusions:
- Direct hemoperfusion with PMX-F is an effective method for removing endotoxin from the blood in patients with severe sepsis or septic MOF.
- The treatment alleviates various endotoxin-induced symptoms and improves hemodynamic stability.
- PMX-F hemoperfusion shows promise as an adjunctive therapy for severe sepsis, warranting further investigation.