Effectiveness of early start of direct hemoperfusion with polymyxin B-immobilized fiber columns judging from stabilization in circulatory dynamics in surgical treatment patients.

Abstract

BACKGROUND:

Septic shock remains a major cause of multiple organ failure and is associated with a high mortality rate. In 1994, direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan and has since been used for the treatment of septic shock arising from endotoxemia.

MATERIALS AND METHOD:

We treated 36 patients with septic shock using direct hemoperfusion with PMX. The patients were analyzed in two groups based on whether they had undergone surgery prior to DHP-PMX treatment (surgical group: surgical treatment before DHP-PMX, medical group: no surgical treatment). In surgical group, DHP-PMX was started within three hours after the surgical treatment. Various factors were measured before and after DHP-PMX.

RESULTS:

The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27.4 +/- 8.8, and the mean sepsis-related organ failure assessment (SOFA) score was 11.8 +/- 4.9 before DHP-PMX. The SOFA score was significantly higher (P = 0.0091) and the PaO2/FiO2 ratio (P/F ratio) was significantly lower (P = 0.0037) in medical group than in surgical group prior to DHP-PMX. A chi-square test showed that the survival rate in surgical group was significantly better than in medical group (P = 0.0027). The survival rate of surgical group (84.2%) was judged to be very good because the predicated survival rate based on the APACHE II score (25.0) was only 46.5%. On the other hand, the survival rate of medical group (35.3%) was almost equal to that predicted by the APACHE II score (30.6; predicted survival rate, 27.4%).

CONCLUSION:

The results of this study suggest the utility of early DHP-PMX in surgical group.

• Authors: Yuichiro Sakamoto, Kunihiro Mashiko, Toru Obata, Hisashi Matsumoto, Yoshiaki Hara, Noriyoshi Kutsukata, Hiroyuki Yokota
• Journal: Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine (Indian J Crit Care Med) Vol. 14 Issue 1 Pg. 35-9 (Jan 2010) ISSN: 1998-359X [Electronic] India
• PMID: 20606907 (Publication Type: Journal Article)