Reevaluation of direct hemoperfusion with polymyxin-B immobilized fiber for severe sepsis and septic shock

Abstract

Direct hemoperfusion with polymyxin-B immobilized fiber (PMX-DHP) developed and currently in use in Japan, has not yet been evaluated abroad. We performed a retrospective study to reevaluate PMX-DHP for severe sepsis or septic shock patients in our intensive care unit. Objective and Method: Sepsis was diagnosed according to the criteria of American College of Chest Physicians and Society for Critical Care Medicine Consensus Conference Committee. We enrolled 301 patients in whom PMX-DHP has been performed for severe sepsis and septic shock from 1994 to 2010. These patients were allocated into 2 groups: those who survived for at least 28 days after the start of PMX-DHP therapy (S group: 201) and those who did not (NS group: 100). Background factors (age, gender, acute physiology and chronic health evaluationⅡscore, sepsis-related organ failure assessment score, Goris MOF score), hemodynamics (blood pressure, PaO2/FIO2 ratio, catecholamine requirement), inflammatory mediators (IL-6, IL-1ra), endothelial related markers (PAI-1) and procalcitonin levels were examined in each group. Results: On the background factors, only Goris MOF score showed a statistically significant difference among the groups. Blood pressure and PaO2/FIO2 ratio both improved markedly immediately after PMX-DHP. Also, the average required amount of catecholamines decreased after PMX-DHP. IL-6, IL-1ra and PAI-1levels decreased immediately after PMX-DHP in both groups. Conclusions: We confirmed an improvement in pulmonary oxygenation and hemodynamic parameters using PMX-DHP for severe sepsis and septic shock patients. The levels of various inflammatory mediators decreased using PMX-DHP, but we did not find any correlation between these changes and outcome.