Septic shock is the most severe form of
sepsis. It is widely accepted that
cytokines play pivotal roles in the pathophysiology of
septic shock. We reported previously that continuous
hemodiafiltration (CHDF) using a
polymethylmethacrylate (
PMMA) membrane hemofilter removed various
cytokines from blood continuously and efficiently, mainly by adsorption to membrane matrix of the hemofilter. Furthermore, in April 2000, we introduced to clinical practice a rapid assay system that determines blood levels of IL (interleukin)-6 in approximately 30 min. This enabled us to routinely measure blood
IL-6 as an index of
cytokine cascade activation in
critically ill patients for real-time clinical monitoring of
hypercytokinemia. The aim of the present cohort study was to evaluate the clinical efficacy of
PMMA-CHDF in
septic shock, a typical condition associated with
hypercytokinemia. Forty-three patients with
septic shock were assessed by monitoring of blood
IL-6 level with a rapid assay system and immediate initiation of
critical care including
PMMA-CHDF for
cytokine removal. Following initiation of
PMMA-CHDF, early improvement of hemodynamics was noted, as well as an increase in urine output.
PMMA-CHDF treatment improved both
hypercytokinemia (assessed by measurement of blood IL-6 level) and dysoxia (assessed by measurement of blood
lactate level). The present findings suggest that
cytokine-oriented
critical care using
PMMA-CHDF might be an effective strategy for the treatment of
septic shock.