Endotoxin adsorption therapy by polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) has been used for the treatment of septic shock patients. Endotoxin, an outer membrane component of Gram-negative bacteria, plays an important role in the pathogenesis of septic shock. Endotoxin triggers a signaling cascade for leukocytes, macrophage, and endothelial cells to secrete various mediators including cytokines and nitric oxide, leading to septic shock and multiple organ dysfunction syndrome. PMX-DHP directly adsorbed not only endotoxin but also monocytes and anandamide. It reduced blood levels of inflammatory cytokines such as interleukin (IL)-1, IL-6, tumor necrosis factor-alpha and IL-17A, adhesion molecules, plasminogen activator inhibitor 1, and high mobility group box-1. As a result, PMX-DHP increased blood pressure and reduced the dose of vasoactive-inotropic agents. PMX-DHP improved monocyte human leukocyte antigen-DR expression in patients with severe sepsis and septic shock. A post hoc analysis of EUPHRATES (Evaluating the Use of Polymyxin B Hemoperfusion in Randomized Controlled Trial of Adults Treated for Endotoxemia and Septic Shock) trial has shown that PMX-DHP significantly reduced 28-day mortality compared with the control group in septic shock patients with endotoxin activity assay level between 0.60 and 0.89. Longer duration of PMX-DHP may be another strategy to bring out the beneficial effects of PMX-DHP. Further studies are needed to confirm the efficacy of PMX-DHP treatment for septic shock.
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TLR2 and NLRP3 Orchestrate Regulatory Roles in Escherichia coli Infection-Induced Septicemia in Mouse Models Zhiguo Gong, Wei Mao, Jiamin Zhao, Peipei Ren, Zhuoya Yu, Yunjie Bai, Chao Wang, Yuze Liu, Shuang Feng, Surong Hasi Journal of Innate Immunity.2024; 16(1): 513. CrossRef
Methods of Extracorporeal Hemocorrection in Sepsis (Review) V. A. Kovzel, L. A. Davydova, A. V. Karzin, S. V. Tsarenko, V. Yu. Baturova, A. A. Polupan, A. I. Gutnikov General Reanimatology.2023; 19(2): 68. CrossRef
Modifications of peripheral perfusion in patients with vasopressor-dependent septic shock treated with polymyxin B-direct hemoperfusion Motohiro Sekino, Yu Murakami, Shuntaro Sato, Ryosuke Shintani, Shohei Kaneko, Naoya Iwasaki, Hiroshi Araki, Taiga Ichinomiya, Ushio Higashijima, Tetsuya Hara Scientific Reports.2023;[Epub] CrossRef
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Direct hemoperfusion therapy with a polymyxin B-immobilized fiber column (PMX-HP) has been introduced as a therapeutic option for gram negative bacterial septic shock in adults. However, its use in neonates and children has not yet been established. We successfully performed hemoperfusion therapy using an adult polymyxin B-immobilized fiber column in a neonate with carbapenem resistant Acinetobacter baumannii septic shock. The application was technically feasible because the neonate was on extracorporeal membrane oxygenation (ECMO). Although it did not rescue the patient, there was significant short-lasting improvement in pulmonary oxygenation and hemodynamics, leading to wean the patient from ECMO. PMX-HP could be used as an adjunctive treatment for selected neonatal and pediatric patients with gram negative bacterial septic shock.
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Effects of continuous renal replacement therapy with the AN69ST membrane for septic shock and sepsis-induced AKI in an infant: a case report with literature review of cytokine/mediator removal therapy in children Naoto Nishizaki, Riko Ueno, Yuki Nagayama, Hanako Abe, Akina Matsuda, Akira Mizutani, Kaoru Obinata, Tadaharu Okazaki, Toshiaki Shimizu Renal Replacement Therapy.2020;[Epub] CrossRef
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Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.
The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported. However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases of intra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatment improved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated with septic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractility assessed by echocardiography returned to baseline. In case 3, a patient with Burkitt’s lymphoma and neutropenia was found to be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parameters improve after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was more significant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged from the hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients with refractory intra-abdominal infection associated with septic shock.
BACKGROUND Paraquat has been widely used as a non-selective contact herbicide and it may induce damage to many organs.
This study aimed to assess the factors that can predict the prognosis of paraquat poisoning and to determine the effect of hemoperfusion. METHODS We retrospectively reviewed 132 patients who were poisoned with paraquat from January 2005, to December 2008.
The patients were divided into two groups: The first groups included the death and survived groups, and the second groups included the hemoperfusion and non-hemoperfusion groups. We investigated the mortality, the factors that can predictive the prognosis and the effect of hemoperfusion. RESULTS There were 79 males and 53 female (mean age: 56.1 +/- 15.1 years). The significant differences between the death and survival groups were the volume of paraquat ingested, the mental status, GCS (Glasgow coma scale), pH, base deficit, HCO3, serum Cr (creatinine), serum AST (aspartate transaminase), serum glucose, K (kalium), urine sodium dithionite test and hemoperfusion. The significant differences between the hemoperfusion and non-hemoperfusion groups were the mortality and the mean survival time.
Multivariate regression analysis reveled four predictive factors and their's Odd ratio: 1) urine sodium dithionate test = strong 14.256, 2) hemoperfusion 0.493, 3) Cr > 0.95 mg/kg 31.603 and 4) an amount of ingested paraquat > 45 ml 16.945. CONCLUSIONS The predictive factors for mortality were the amount of paraquat ingested > 45 ml, a urine sodium dithionite test = strong and a serum Cr > 0.95 mg/dl.
Hemoperfusion couldn't be used a predictive factor for mortality, but it increased the mean survival time.
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Prediction of Mortality in Patients with Acute Paraquat Intoxication Using Simplified Acute Physiology Score II Young-yeol You, Younggi Min, Junghwan Ahn, Sang-Cheon Choi, Yeonho Shin, Yoonseok Jung, Eunjung Park The Korean Journal of Critical Care Medicine.2011; 26(4): 221. CrossRef
BACKGROUND To analyze hemodynamic changes during single catheter technique of hepatic venous isolation and extracorporeal charcoal hemoperfusion for malignant liver tumor. METHODS: Drugs for chemotherapy were infused to the liver through hepatic artery. With 4-lumen- 2-balloon (4L-2B) catheter, hepatic venous blood was circulated to the extracorporeal charcoal system. During extracorporeal charcoal system circulation, drugs were eliminated and the blood was reinfused to supra-hepatic vein-IVC. At the same time, IVC was clamped. Systemic vascular resistance index (SVRI), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), heart rate (HR) and arterial blood gas were measured after 4L-2B catheter insertion (T1), during test circulation (T2), after 20min chemotherapy (T3) and after 10min reperfusion (T4). RESULTS: MAP was decreased at T3 compared to T1 and increased at T4 compared to T3. CI was decreased at T3 and increased at T4 compared to T1. SVRI was decreased at T4 compared to T1. HR was increased at T2 and T3 compared to T1. SVI was decreased at T2 and T3 compared to T1. CONCLUSIONS: During clamping of IVC, MAP is decreased by decreased SVI in spite of increased HR. After IVC is released and the stagnated blood of lower extremity is recirculated, the MAP is returned to the value of after catheter insertion by increased SVI in spite of decreased SVRI.