The Severity of Hyperdynamic Circulation May Predict the Effects of Direct Hemoperfusion with the Adsorbent Column Using Polymyxin B‐Immobilized Fiber in Patients with Gram‐Negative Septic Shock

Abstract

It has been reported that direct hemoperfusion with the adsorbent column using polymyxin B‐immobilized fiber (DHP with PMX‐F column) ameliorates hyperdynamic circulation in septic shock and improves survival rate. However, the clinical characteristics of patients with an improvement of septic shock after DHP with PMX‐F column have not been evaluated. To clarify this issue, the clinical profiles of 46 patients who were suggested to have gram‐negative septic shock and treated using DHP with PMX‐F column were analyzed retrospectively. Of 46 patients, 31 were diagnosed with gram‐negative septic shock (G group). Mean arterial pressure (MAP) just before DHP with PMX‐F column was not different between the G and the non‐G group. As compared with the non‐G group, the G group had a higher cardiac index (CI) and a lower systemic vascular resistance (SVR). Significant increases in MAP and SVR with a significant decrease in CI were observed after DHP with PMX‐F column in the G group. In the non‐G group, MAP was significantly increased after the DHP therapy, but systemic hemodynamics were unchanged. Patients in the G group who fulfilled the following criteria were considered as the effective group: MAP was elevated more than 10 mm Hg or 125% of the basal MAP and/or the dose of vasopressors was reduced after DHP with PMX‐F column. Twenty‐one patients (67.8%) were in the effective group. In comparison with the effective group, the noneffective group was characterized by a significant increase in CI before DHP with PMX‐F column. All patients with a CI less than 6 L/min/m2 were in the effective group. These data suggest that DHP with PMX‐F column was useful for patients with Gram‐negative septic shock who did not have severe hyperdynamic circulation.

Hemoperfusion with an Immobilized Polymyxin B Column Reduces the Blood Level of Neutrophil Elastase

“…No standard criteria for the use of DHP with PMX have been established, so some medical institutions start treatment depending on the APACHE-II score [13,14] , cardiac index [15] , or interleukin-6 level [16] . This treatment has generally been reserved for patients with severe sepsis or septic shock.…”

Efficacy of an Extracorporeal Endotoxin Adsorber System during Hyperdynamic Porcine Endotoxemia

“…Nevertheless, considering the central importance of LPS in the pathogenesis of sepsisrelated multiple organ failure, it seems logical to remove LPS from the circulation, and extracorporeal devices specifically designed to adsorb endotoxin may represent an attractive alternative. One approach, using hemoperfusion through a column of immobilized polymyxin B that selectively binds endotoxins [11] , was well tolerated and resulted in improved hemodynamic variables in animal and human studies [12][13][14] .…”

Sorbents in Acute Renal Failure and the Systemic Inflammatory Response Syndrome

“…The device has met with success not only in reducing endotoxin [11,12], but also was associated with reduction in IL-6 and erythropoietin in patients with septic shock [27].…”

“…The approaches used are given in table 1. These include push-pull apheresis [6,7], coupled plasma filtration adsorption [8][9][10], hemoadsorption (to be discussed here) and adsorption of endotoxin on polymyxin-B-immobilized fibers [11,12].…”