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

Chizuru Yamashita, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Osamu Nishida

研究成果: Article

8 引用 (Scopus)

抄録

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.

元の言語English
ページ(範囲)316-323
ページ数8
ジャーナルTherapeutic Apheresis and Dialysis
19
発行部数4
DOI
出版物ステータスPublished - 01-08-2015

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Hemoperfusion
Polymyxin B
Septic Shock
Sepsis
Therapeutics
Catecholamines
Hemodynamics
Lung Volume Measurements
Dobutamine
Adult Respiratory Distress Syndrome
Epinephrine
Dopamine
Norepinephrine
Arterial Pressure
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Hematology
  • Nephrology

これを引用

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abstract = "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.",
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Clinical Effects of a Longer Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion Therapy for Severe Sepsis and Septic Shock. / Yamashita, Chizuru; Hara, Yoshitaka; Kuriyama, Naohide; Nakamura, Tomoyuki; Nishida, Osamu.

:: Therapeutic Apheresis and Dialysis, 巻 19, 番号 4, 01.08.2015, p. 316-323.

研究成果: Article

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AU - Yamashita, Chizuru

AU - Hara, Yoshitaka

AU - Kuriyama, Naohide

AU - Nakamura, Tomoyuki

AU - Nishida, Osamu

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N2 - 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.

AB - 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.

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