Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation

Shimizu, Tomoharu; Hanasawa, Kazuyoshi; Sato, Koichi; Umeki, Masahiko; Koga, Nobuhiko; Naganuma, Tatsushi; Sato, Seiji; Shimonishi, Tomonori; Matsuno, Naoto; Ono, Satoshi; Saitoh, Hitoshi; Satoh, Koshi; Otani, Yoshimasa; Endo, Yuichi; Eguchi, Yawara; Tani, Tohru

doi:10.1007/s00423-008-0395-2

Cited by 33 publications

(19 citation statements)

References 42 publications

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“…Our results were similar to the findings of previous studies [10,11,12], which showed that survivors commenced PMX earlier after the onset of shock than patients who died. In patients with severe sepsis or septic shock, early administration of appropriate antibiotics, corticosteroids, and recombinant human activated protein C are all associated with better survival [13].…”

Section: Discussionsupporting

confidence: 83%

Time to Initiation of Treatment with Polymyxin B Cartridge Hemoperfusion in Septic Shock Patients

Takeyama

Noguchi²,

Hirakawa³

et al. 2012

Blood Purif

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Background: We investigated whether early initiation of hemoperfusion with a polymyxin B cartridge (PMX) after the diagnosis of septic shock could improve the clinical outcome. Methods: A prospective, open-labeled, multicenter cohort study was performed at intensive care units in Japan. 41 patients received PMX within 6 h after the diagnosis of septic shock (early group) and 51 patients were treated after 6 h (late group). Results: The early group had a significantly shorter duration of ventilator support and also had a lower catecholamine requirement. PMX was effective for improvement of hypotension, hypoperfusion, the sequential organ failure assessment score, and pulmonary oxygenation regardless of the timing of its initiation. The 28-day mortality rate did not differ between the two groups. Conclusions: Early initiation of PMX shortened the duration of ventilator support and also reduced the catecholamine requirement, so early treatment of septic shock should achieve a better outcome.

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Section: Discussionsupporting

confidence: 83%

Time to Initiation of Treatment with Polymyxin B Cartridge Hemoperfusion in Septic Shock Patients

Takeyama

Noguchi²,

Hirakawa³

et al. 2012

Blood Purif

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“…The authors hypothesized that the delay in initiation of therapy had an impact on survival. Comparable results were seen in patients with colorectal sepsis [29] and septic multiorgan failure [16]. …”

Section: Refining the Treatment Strategy: Time-to-initiation Of Pmxmentioning

confidence: 70%

New Trends in Polymyxin B Hemoperfusion: From 2006 to 2013

Cruz¹

2014

Blood Purif

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Endotoxin, one of the principal components on the outer membrane of Gram-negative bacteria, is considered a key and early component in the pathogenesis of sepsis. Polymyxin B bound to polystyrene fibers (PMX) is a medical device capable of removing circulating endotoxin by adsorption. The most comprehensive analysis to date of clinical experience with this device remains a meta-analysis of 28 studies between 1998 and 2006. This showed that PMX hemoperfusion was associated with improved blood pressure and a reduction in dopamine dose, improved PaO₂/FiO₂ ratio and lower mortality. Since this meta-analysis, over 50 additional studies on PMX have been published. The majority are observational, with small sample sizes. Notable among the newer studies is the increasing interest in the use of PMX therapy in interstitial pneumonias and idiopathic pulmonary fibrosis, as well as in longer treatment duration and earlier initiation of PMX therapy in an attempt to further improve clinical outcomes. These observational data highlight important aspects of PMX therapy worthy of more rigorous investigation in future studies.

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“…However, whether PMX-DHP removes cytokines remains controversial [8,28]. A recent multicenter study on PMX-DHP reports the adsorption of endotoxin and also the modulation of circulating cytokines in septic patients [29].…”

Section: Discussionmentioning

confidence: 99%

HMGB-1 as a Useful Prognostic Biomarker in Sepsis-Induced Organ Failure in Patients Undergoing PMX-DHP

Ueno¹,

Ikeda²,

Ikeda³

et al. 2011

Journal of Surgical Research

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Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation

Abstract: Our findings suggested that PMX treatment appears to adsorb endotoxin and also modulates circulating cytokine during a 2-h interval of direct hemoperfusion in septic patients with such condition.

Cited by 33 publications

References 42 publications

Time to Initiation of Treatment with Polymyxin B Cartridge Hemoperfusion in Septic Shock Patients

Time to Initiation of Treatment with Polymyxin B Cartridge Hemoperfusion in Septic Shock Patients

New Trends in Polymyxin B Hemoperfusion: From 2006 to 2013

HMGB-1 as a Useful Prognostic Biomarker in Sepsis-Induced Organ Failure in Patients Undergoing PMX-DHP

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