Clinical Effects of a Longer Duration of Polymyxin B‐Immobilized Fiber Column Direct Hemoperfusion Therapy for Severe Sepsis and Septic Shock. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Yamashita, Chizuru; Hara, Yoshitaka; Kuriyama, Naohide; Nakamura, Tomoyuki; Nishida, Osamu
• Is Part Of: Therapeutic apheresis and dialysis. Volume 19:Issue 4(2015)
• Page Start: 316
• Page End: 323
• Publication Date: 2015-08
• Subjects: Hemapheresis -- Periodicals; Dialysis -- Periodicals; Blood Component Removal -- Periodicals; Renal Dialysis -- Periodicals; Hémaphérèse -- Périodiques; Dialyse -- Périodiques; Sang -- Collecte et conservation -- Périodiques; 616
• DOI: 10.1111/1744-9987.12339
• Languages: English
• ISSNs: 1744-9979

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <p>Polymyxin B‐immobilized fiber column direct hemoperfusion (PMX‐DHP) therapy is widely used for the treatment of severe sepsis and septic shock, and is generally performed for 2 h. Although previous studies demonstrated the efficacy of PMX‐DHP therapy, it currently remains unclear whether its optimal duration is 2 h. This retrospective study analyzed 37 patients with septic shock who showed a poor clinical response to 2 h of PMX‐DHP, and underwent a longer duration of this therapy. The mean duration of PMX‐DHP therapy was 15.8 ± 7.9 h, and none of the patients developed adverse events, which enabled the therapy to be performed safely. The pressure catecholamine index [CAIP = catecholamine index/mean arterial pressure; catecholamine index = dopamine + dobutamine + (adrenaline + noradrenaline) × 100 μg/kg per min], as an indicator of hemodynamics, improved significantly in the survival group in the period between the start and 24 h after the end of PMX‐DHP therapy (<italic>P</italic> < 0.01), and between 2 h after the start of and the end of this therapy (<italic>P</italic> < 0.05). In addition, the P/F ratio improved significantly in the group of surviving patients with acute respiratory distress syndrome (ARDS) in the period between the start and 24 h after the end of PMX‐DHP therapy (<italic>P</italic> < 0.01), and between 2 h after the start of and the end of this therapy (<italic>P</italic> < 0.01). These results suggest that a longer duration of PMX‐DHP therapy can be expected to improve the hemodynamics and pulmonary oxygenation capacity of patients with severe sepsis/septic shock. Strict prospective studies are needed in the future.</p> </abstract>