Clinical Effects of a Longer Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion Therapy for Severe Sepsis and Septic Shock

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 2h. Although previous studies demonstrated the efficacy of PMX-DHP therapy, it currently remains unclear whether its optimal duration is 2h. This retrospective study analyzed 37 patients with septic shock who showed a poor clinical response to 2h of PMX-DHP, and underwent a longer duration of this therapy. The mean duration of PMX-DHP therapy was 15.8±7.9h, 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)×100μg/kg per min], as an indicator of hemodynamics, improved significantly in the survival group in the period between the start and 24h after the end of PMX-DHP therapy (P<0.01), and between 2h after the start of and the end of this therapy (P<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 24h after the end of PMX-DHP therapy (P<0.01), and between 2h after the start of and the end of this therapy (P<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.