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[Treatment of sepsis by extracorporeal elimination of endotoxin using fiber-immobilized polymyxin B]
1First Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Abstract:
To remove endotoxin directly from the blood, an affinity adsorbent (PMX) has been developed. PMX is composed of a ligand of polymyxin B and a carrier of polystyrene fibers. We treated 16 patients, suffering from septic shock or multiple organ failure by PMX-F hemoperfusion. The pretreatment level of endotoxin decreased significantly from 80pg/ml to 21pg/ml on average 2 hours after the hemoperfusion. The hyperdynamic status in the cardiac index and the decreased systemic vascular resistance, which are characteristic to endotoxin shock, were normalized after the treatment. In septic shock patients with systolic pressure under 10mmHg, the systolic pressure increased significantly from pretreatment level. Nine of the sixteen patients remained alive for two weeks after the therapy, and seven out of the nine patients discharged alive. Hemoperfusion with PMX is likely to become an effective treatment for sepsis and septic shock.
Insights
This study shows polymyxin B (PMX) hemoperfusion effectively removes endotoxin from blood in patients with septic shock. This treatment improved hemodynamic status and survival rates, suggesting PMX is a promising therapy for sepsis.
Area of Science:
- Biomedical Engineering
- Critical Care Medicine
- Toxicology
Background:
- Sepsis and septic shock are life-threatening conditions often caused by endotoxin.
- Current treatments for endotoxin removal are limited.
- Polymyxin B (PMX) is an antibiotic with endotoxin-binding properties.
Purpose of the Study:
- To evaluate the efficacy of PMX-F hemoperfusion for direct endotoxin removal from blood.
- To assess the impact of PMX-F hemoperfusion on hemodynamic parameters in patients with septic shock.
- To determine the survival rates of patients treated with PMX-F hemoperfusion.
Main Methods:
- Developed an affinity adsorbent (PMX) using polymyxin B ligand on polystyrene fibers.
- Treated 16 patients with septic shock or multiple organ failure using PMX-F hemoperfusion.
- Monitored endotoxin levels, cardiac index, systemic vascular resistance, and systolic blood pressure before and after treatment.
Main Results:
- Endotoxin levels significantly decreased from 80 pg/ml to 21 pg/ml on average 2 hours post-hemoperfusion.
- Hyperdynamic circulation and low systemic vascular resistance characteristic of endotoxin shock were normalized.
- Systolic blood pressure increased significantly in patients with hypotension (under 10 mmHg).
- Nine out of 16 patients survived for two weeks; seven were discharged alive.
Conclusions:
- PMX-F hemoperfusion effectively removes endotoxin from the blood.
- The treatment improves hemodynamic instability associated with septic shock.
- PMX-F hemoperfusion demonstrates potential as an effective therapeutic option for sepsis and septic shock.