Criteria for Direct Hemoperfusion With an Immobilized Polymyxin B Fiber Column Based on Oxygen Metabolism

Abstract

The optimum time for commencement of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) in patients with sepsis remains unclear. We retrospectively studied the response to DHP-PMX in relation to parameters of oxygen metabolism in 48 patients with sepsis who were divided into two groups. In the effective group (N = 36), the mean blood pressure increased by at least 10 mm Hg after DHP-PMX. Patients who did not show such a blood pressure elevation were assigned to the non-effective group (N = 12). Before the start of therapy, various parameters (mixed venous oxygen saturation, oxygen delivery index, oxygen consumption index (VO(2)I), oxygen extraction ratio, gastric mucosal-arterial PCO(2) difference, age, systemic vascular resistance index, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score were measured in both groups. These parameters were then compared between the two groups. Only VO(2)I showed a significant difference between the two groups, and all patients in the effective group had a VO(2)I of 100 mL/min/m(2) or more. Based on these results, DHP-PMX should be introduced during the period when VO(2)I is still equal to or greater than 100 mL/min/m(2).

Hemoperfusion With an Immobilized Polymyxin B Fiber Column Decreases Macrophage and Monocyte Activity

“…Once shock occurs and organ ischemia progresses, cellular dysfunction becomes severe at the molecular level. This makes it difficult to assess the response to DHP‐PMX; therefore, we selected our patients according to the above criteria (17).…”

“…The criteria for inclusion in the study were the following findings within the previous 24 h: (i) signs of SIRS due to infection, including fever or hypothermia (temperature >38°C or <36°C, respectively), tachycardia (>90/min), tachypnea (>20/min), or P a CO 2 <32 mm Hg or mechanical ventilation, and a white blood cell count >12.0 10 4 /L or <4.0 10 4 /L or at least 10% immature neutrophils; (ii) mean arterial pressure >60 mm Hg irrespective of the use of catecholamines; (iii) stable global oxygen metabolism (DO 2 I > 500 mL/min/m 2 and VO 2 I > 100 mL/min/m 2 ) (17); and (iv) antibiotic therapy to minimize LPS release by Gram‐negative rods. Exclusion criteria were an age under 18 years and a mean blood pressure ≤60 mm Hg, irrespective of the use of catecholamines.…”

Hemoperfusion With a Polymyxin B Fiber Column Decreases Clotting Activity

“…Our selection criteria targeting global oxygen metabolism and the mean blood pressure were based on the concept that DHP‐PMX should be started before the tissues and cells have been significantly affected by sepsis, even if some organ dysfunction is present. Once shock occurs and organ ischemia progresses, cellular dysfunction becomes severe at the molecular level and this makes it difficult to assess the response to DHP‐PMX; therefore, we selected our patients according to the above criteria (14).…”