No abstract

The aim of this study is to evaluate the impact of neutral microporous resin hemoperfusion on hemodynamic improvement, removal of inflammatory cytokines, and mortality in critical care patients with severe sepsis. Forty-four patients with severe sepsis or septic shock were randomized to HA type hemoperfusion treatment (N=24) or standard therapy (N=20). Those undergoing hemoperfusion treatment received HA330 hemoperfusion. We measured the plasma concentrations of IL-6 and IL-8 at the start of every hemoperfusion treatment, and the following parameters were compared between the control group and the hemoperfusion group on days 3, 7, and 14: hemodynamics (cardiac index, systemic vascular resistance index, heart rate, and mean arterial pressure); change of hematology and coagulation function; organ function; and the sequential organ failure assessment (SOFA) score. Hospital, 28-day, and ICU mortality were also observed. Patients treated with HA hemoperfusion showed a significant removal of plasma IL-6 and IL-8 over time while in the study. Patients in the HA group also demonstrated significant increases in cardiac index, systemic vascular resistant index, fast withdrawal of vasoactive agents and decreases in heart rate compared with the controls at days 3 and 7. Although there was no significant difference between the groups in organ dysfunction as assessed by SOFA scores from day 0 (baseline) to day 7, significant improvement can be demonstrated in the hemoperfusion group at day 14. There was no significant difference between the groups in 28-day mortality, hospital mortality, or length of hospital stay, but ICU mortality and the length of ICU stay in the HA group were markedly reduced. Hemoperfusion treatment using the HA type cartridge in sepsis is safe and it may improve organ dysfunction, ICU mortality, and shorten the length of ICU stay. Clinical significant removal of inflammatory cytokines such as IL-6 and IL-8 from circulation by hemoperfusion may contribute to improving a patient's outcome in an ICU.

The aim of this study was to investigate the effect of neutral microporous resin hemoperfusion on oxygenation improvement, removal of inflammatory cytokines in plasma and bronchoalveolar lavage, and mortality in acute lung injury induced by extrapulmonary sepsis. Forty-six patients with acute lung injury induced by extrapulmonary sepsis were randomized to HA type hemoperfusion treatment (N=25) or standard therapy (N=21). Those undergoing hemoperfusion treatment received HA330 hemoperfusion. We measured the plasma and bronchoalveolar lavage concentrations of TNF-α and IL-1, and the following parameters were compared between the control group and the hemoperfusion group on days 0, 3 and 7: lung injury measurements (arterial oxygen tension/fractional inspired oxygen ratio, lung injury score, chest X-ray score); interstitial edema of lung (extravascular lung water). Duration of mechanical ventilation, hospital, 28-day, and intensive care unit mortality were also observed. Patients treated with HA hemoperfusion showed a significant removal of plasma and bronchoalveolar lavage TNF-α and IL-1 over time while in the study. Patients in the HA group also demonstrated not only significant improvement of PaO2 /FiO2 , but also decreased Lung Injury Score and chest X-ray score at days 3 and 7. Furthermore, the measurements of the arterial oxygen tension/fractional inspired oxygen ratio, lung injury score and extravascular lung water (EVLWI) significantly correlated with and the concentration of cytokines in the plasma (all P<0.05). The HA hemoperfusion treatment group had a significant reduction in duration of mechanical ventilation, length of intensive care unit stay, and intensive care unit mortality. Significant removal of inflammatory cytokines from circulation and lung by hemoperfusion treatment using the HA type cartridge may contribute to the improvement of lung injury and intensive care unit outcome in extrapulmonary septic patients.