Clinical Effects of Direct Hemoperfusion Using a Polymyxin-B Immobilized Column in Solid Organ Transplanted Patients with Signs of Severe Sepsis and Septic Shock. a Pilot Study

Abstract

Background Polymyxin B (PMX-B) is a polycationic antibiotic, known to bind the lipid A portion of endotoxin, a cell wall component found exclusively in gram negative bacteria (GNB). An extracorporeal hemoperfusion device (TORAYMYXIN) has been developed: PMX is covalently bound on the surface of an insoluble carrier material so that the endotoxin can be inactivated in the blood without exerting its toxicity on the brain and kidney The aim of this study was to clarify the efficacy, safety and clinical effects of direct hemoperfusion with an immobilized polymyxin-B fiber column (DHP-PMX) in solid organ transplanted patients with severe sepsis or septic shock. Methods From June 2004 to May 2005, 15 patients (10 men and 5 women), mean age 55 years old (46–65 range), underwent kidney or liver transplantation and developed severe sepsis or septic shock, as defined by the Consensus Conference of American College Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria. GNB were detected in all the patients receiving conventional treatments including antibiotic therapy, vasopressive or inotropic agents, and ventilation support. The DHP-PMX treatment was performed three times in each patient. Hemodynamic and respiratory parameters, dosage of vasopressor/inotropic drugs were assessed at baseline and after each treatment. Results No adverse events occurred. From baseline to 3rd treatment, mean arterial pressure (MAP) was increased (from 63±5 to 83±4 mmHg), while the dosage of dobutamine (from 7.5±3 to 3±2 mcg/kg/min) and noradrenaline (from 1.3±0.45 to 0.05±0.02 mcg/kg/min) were reduced. The PaO2/FiO2 ratio increased (from 234±38.47 to 290±107.48 mmHg). Conclusion The use of DHP-PMX in association with conventional therapy may be an important aid in patients with sepsis.

Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock

“…Improvement in blood pressure and reduction in vasopressor doses have also been demonstrated in other studies. 29,30 In our study, even as the dose of vasoactive agents (indicated by the inotropic score) was reduced, there was a significant increase in MAP in the polymyxin B hemoperfusion group at 72 hours (Table 3). Accordingly, the vasopressor dependency index decreased significantly in the polymyxin B hemoperfusion group but not in the conventional therapy group.…”

“…The results of our study shed light on this controversial matter. In this RCT of surgical patients with septic shock and severe sepsis induced by abdominal sepsis, polymyxin B hemoperfu- .50 6 (20) 8 (30) .50…”

Newly Designed CRRT Membranes for Sepsis and SIRS—A Pragmatic Approach for Bedside Intensivists Summarizing the More Recent Advances

“…Sepsis can directly induce AKI without the need of hemodynamic instability. 36 Mortality was not assessed. 34 The Early Use of Polymyxin B Hemoperfusion in Abdominal Sepsis (EUPHAS) study was recently published and was relatively unique as it was targeting a population that was likely to exhibit high circulating levels of endotoxin and in whom the source of sepsis was definitely cured by initial surgery.…”

Continuous Renal Replacement Therapy in Sepsis: Should We Use High Volume or Specific Membranes?

“…PMX B treatment was also studied in solid organ transplant patients with severe sepsis and septic shock. Despite three PMX sessions, no hemodynamic improvement was noticed [ 74 ]. Mortality was not assessed in this population.…”