Direct Hemoperfusion Using Polymyxin-B Immobilized Fiber for Septic Shock After Cardiac Surgery

Murakami, Masanori; Miyauchi, Yoshimasa; Nishida, Masahiko; Okada, Haruhiko; Hamano, Kimikazu

doi:10.1253/circj.cj-08-0503

Cited by 9 publications

(6 citation statements)

References 12 publications

(9 reference statements)

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“…Selective LPS-adsorption procedures might improve hemodynamic and respiratory parameters. The increased MAP levels and decreased inotropic support observed in our patients have also been described in other publications (15––17).…”

Section: Discussionsupporting

confidence: 91%

Endotoxin Adsorption using Polymyxin B Immobilized Fiber Cartridges in Severe Sepsis Patients following Cardiac Surgery

et al. 2014

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Section: Discussionsupporting

confidence: 91%

Endotoxin Adsorption using Polymyxin B Immobilized Fiber Cartridges in Severe Sepsis Patients following Cardiac Surgery

et al. 2014

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“…Similar changes are described in other trials studying the selective adsorption of endotoxin [14,15] or in conjunction with CPFA [16,17]. …”

Section: Discussionsupporting

confidence: 63%

A Pilot Study of Selective Lipopolysaccharide Adsorption and Coupled Plasma Filtration and Adsorption in Adult Patients with Severe Sepsis

Yaroustovsky¹,

Abramyan²,

Кротенко³

et al. 2015

Blood Purif

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Aim: To evaluate the safety and effectiveness of combined extracorporeal therapy in patients with severe sepsis after cardiac surgery. Materials and Methods: Twenty patients received combined extracorporeal therapy (LPS-adsorption with Toraymyxin columns + CPFA). The inclusion criteria were clinical signs of severe sepsis, EAA = 0.6, and PCT >2 ng/ml. 20 comparable patients in the control group received only standard therapy. Results: Each patient in the study group received 2 daily treatments of combined extracorporeal therapy. In contrast to controls, we noted an increase in the values of MAP from 73 to 82 mm Hg, (p < 0.001) and the mean oxygenation index (from 180 to 246, p < 0.001), decrease of EAA from 0.77 to 0.55, p < 0.001, and PCT (from 6.23 to 2.83 ng/ml, p < 0.001). The 28-day survival rate was 65 and 35% in the study and control groups respectively, p = 0.11. Conclusion: The combined use of LPS-adsorption and CPFA in a single circuit with standard therapy is a safe and possibly effective adjunctive method for treating severe sepsis.

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“…Several studies reported improvement in SVR [ 27 – 31 ], CO, or cardiac index [ 29 , 31 ]. However, pooled data seem to indicate that polymyxin B hemoperfusion should be able to increase blood pressure with the reduction of vasoactive agents [ 29 , 32 – 35 ] compared with conventional treatments [ 36 , 37 ]. Polymyxin B hemoperfusion might improve the oxygenation index and oxygenating lung functions [ 33 , 34 ] possibly because of a reduction in pulmonary epithelium injury, permeability, and endothelial damage.…”

Section: Discussionmentioning

confidence: 99%

Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report

Pota¹,

Passavanti²,

Sansone³

et al. 2018

J Med Case Reports

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BackgroundDescending necrotizing mediastinitis is a common and progressive polymicrobial infection involving the neck and chest with a high death rate (10 to 40%). From a microbiological point of view, descending necrotizing mediastinitis is sustained by Gram-positive bacteria (43–62%), anaerobes (46–78%), and, rarely, Gram-negative bacteria. Data collected during the Antibiotic Resistance-Istituto Superiore di Sanità project confirmed that Italy is positioned among the countries with the highest levels of resistance in most pathogenic species under surveillance. In particular, 32.9% of Klebsiella pneumoniae isolates were resistant to carbapenem, 33.6% of Staphylococcus aureus to methicillin, and 28.7% and 43.9% of Escherichia coli isolates to third-generation cephalosporins and fluoroquinolones, respectively.Case presentationWe describe the case of a 38-year-old white man with septic shock due to descending necrotizing mediastinitis sustained by multidrug-resistant Gram-negative and Gram-positive bacteria treated after surgery with an IgM-enriched immunoglobulin preparation and polymyxin B hemoperfusion therapy.ConclusionDespite the contrasting data on the use of immunoglobulins and polymyxin B hemoperfusion in septic shock and the lack of literature in cases of acute mediastinitis caused by both Gram-negative and Gram-positive multidrug-resistant bacteria, we obtained an improvement in clinical conditions and the survival of our patient, against all odds.

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Direct Hemoperfusion Using Polymyxin-B Immobilized Fiber for Septic Shock After Cardiac Surgery

Cited by 9 publications

References 12 publications

Endotoxin Adsorption using Polymyxin B Immobilized Fiber Cartridges in Severe Sepsis Patients following Cardiac Surgery

Endotoxin Adsorption using Polymyxin B Immobilized Fiber Cartridges in Severe Sepsis Patients following Cardiac Surgery

A Pilot Study of Selective Lipopolysaccharide Adsorption and Coupled Plasma Filtration and Adsorption in Adult Patients with Severe Sepsis

Septic shock from descending necrotizing mediastinitis – combined treatment with IgM-enriched immunoglobulin preparation and direct polymyxin B hemoperfusion: a case report

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