Document Detail


Endotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock.
MedLine Citation:
PMID:  11979337     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Direct hemoperfusion (DHP) with an adsorbent column using polymyxin B-immobilized fiber (PMX-F) has been shown to improve the state of shock in patients with septic shock. However, no evidence has been presented for a direct link between endotoxin removal by DHP with PMX-F and improvement in septic shock. We retrospectively analyzed clinical profiles of 24 patients with septic shock (16 patients, gram-negative; 8 patients, non-gram-negative septic shock) who underwent DHP with PMX-F. Patients with gram-negative septic shock were characterized by hyperdynamic circulation. DHP with PMX-F reduced blood endotoxin concentrations and ameliorated shock, with an improvement in hyperdynamic circulation in patients with gram-negative septic shock. Mean arterial pressure also was elevated after therapy in patients with non-gram-negative septic shock, but systemic hemodynamics were unaffected. Regardless of the causative microorganism, patients with endotoxemia (blood endotoxin level > 10 pg/mL) showed hyperdynamic shock, and DHP with PMX-F reduced blood endotoxin levels and ameliorated hyperdynamic circulation, whereas patients without endotoxemia showed features of shock without hyperdynamic circulation, and DHP with PMX-F ameliorated shock without affecting cardiac performance. In patients with gram-negative septic shock, blood endotoxin concentration correlated positively with cardiac output and negatively with systemic vascular resistance before DHP therapy. Reduction in blood endotoxin concentration by DHP therapy positively correlated with the reduction in cardiac output. Our findings indicate that the improvement in hyperdynamic circulation was related directly to endotoxin removal by the PMX-F column, and endotoxin has an important role in the development of hyperdynamic circulation in patients with gram-negative septic shock.
Authors:
Kohei Uriu; Akihiko Osajima; Kinya Hiroshige; Hiroyuki Watanabe; Keiji Aibara; Yoshifumi Inada; Kayoko Segawa; Hiroshi Anai; Ichiro Takagi; Aki Ito; Masayuki Kamochi; Kazo Kaizu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  39     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-04-29     Completed Date:  2002-06-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  937-47     Citation Subset:  IM    
Copyright Information:
Copyright 2002 by the National Kidney Foundation, Inc.
Affiliation:
Kidney Center, First Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Kitakyusyu, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adsorption
Bacteremia / therapy
Endotoxins / blood*,  pharmacokinetics
Gram-Negative Bacterial Infections / therapy
Gram-Positive Bacterial Infections / therapy
Hemoperfusion / instrumentation*,  methods*
Humans
Middle Aged
Peripheral Vascular Diseases / therapy*
Polymyxin B / metabolism*
Retrospective Studies
Shock, Septic / therapy*
Chemical
Reg. No./Substance:
0/Endotoxins; 1404-26-8/Polymyxin B

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