Impact of Extended Duration of Polymyxin B-immobilized Fiber Column Direct Hemoperfusion on Hemodynamics, Vasoactive Substance Requirement, and Pulmonary Oxygenation in Patients With Sepsis: An Observational Study

Abstract BackgroundPolymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used for patients with septic shock, and the recommended hemoperfusion period is 2 h. However, it remains unclear whether the optimal duration is 2 h or longer. The purpose of this study was to compare the effects of PMX-DHP between conventional and longer duration of PMX-DHP.MethodsWe retrospectively investigated 103 patients with sepsis who underwent PMX-DHP between April 2015 and March 2020. The demographic data, routine biochemistry, microbiological data, primary infection site were reviewed in the medical chart. The acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, heart rate, mean arterial pressure (MAP), vasoactive-inotropic score (VIS), respiratory rate, PaO2/FIO2, at baseline and day 3 were compared between the standard group (patients received 2 h of PMX-DHP) and extended group (patients received more than 2 h of PMX-DHP). Ventilator-free days, incidence of continuous renal replacement therapy, and 28-day mortality were also compared between the groups. ResultsMedian MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (p < 0.05, 0.01, respectively) There were no significant differences in APACHE II score, SOFA score, and PaO2/FIO2 at baseline between the two groups. The increase of MAP and the decrease in VIS from baseline to day 3 were significantly greater in the extended group (p < 0.01, respectively). In the extended group, increase in PaO2/FIO2 was significantly larger in the patients who underwent ≥ 8 h duration than that in patients who underwent < 8 h duration (p < 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups.ConclusionsLonger duration of PMX-DHP effectively improved MAP and decreased the volume of vasoactive-inotropic agents compared with the conventional duration. Eight and longer hours duration of PMX-DHP improved the pulmonary oxygenation. Further studies are needed to confirm the efficacy of longer duration of PMX-DHP in patients with septic shock. (329/350 limits)

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Impact of Extended Duration of Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion on Hemodynamics, Vasoactive Substance Requirement, and Pulmonary Oxygenation in Patients with Sepsis: An Observational Study

Blood Purification ◽

10.1159/000515685 ◽

2021 ◽

pp. 1-8

Author(s):

Chieko Mitaka ◽

Makio Kusao ◽

Izumi Kawagoe ◽

Daizoh Satoh ◽

Toshiaki Iba ◽

...

Keyword(s):

Septic Shock ◽

Sofa Score ◽

Demographic Data ◽

Polymyxin B ◽

Apache Ii ◽

Apache Ii Score ◽

Standard Group ◽

Direct Hemoperfusion ◽

Group 2 ◽

Extended Group

Introduction: Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used for patients with septic shock, and the recommended hemoperfusion period is 2 h. However, it remains unclear whether the optimal duration is 2 h or longer. The purpose of this study was to compare the effects of PMX-DHP between conventional and longer duration of PMX-DHP. Methods: We retrospectively investigated 103 patients with sepsis who underwent PMX-DHP. The demographic data, routine biochemistry, microbiological data, and primary infection site were reviewed in the medical chart. The acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, heart rate, mean arterial pressure (MAP), vasoactive-inotropic score (VIS), and PaO2/FiO2, at baseline and day 3, were compared between the standard group (2 h of PMX-DHP) and the extended group (>2 h of PMX-DHP). Results: Median MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (p < 0.05, 0.01, respectively) There were no significant differences in APACHE II score, SOFA score, and PaO2/FiO2 at baseline between the 2 groups. The increase of MAP and the decrease in VIS from baseline to day 3 were significantly greater in the extended group (p < 0.01, respectively). In the extended group, increase in PaO2/FiO2 was significantly larger in the patients who underwent ≥8 h duration than that in patients who underwent <8 h duration (p < 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups. Discussion/Conclusions: Longer duration of PMX-DHP was associated with the improved MAP and decreased volume of vasoactive-inotropic agents compared with the conventional duration. Eight and longer hours duration of PMX-DHP was associated with the improvement in the pulmonary oxygenation. Further studies are needed to confirm the efficacy of longer duration of PMX-DHP in patients with septic shock.

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SOFA score is superior to APACHE-II score in predicting the prognosis of critically ill patients with acute kidney injury undergoing continuous renal replacement therapy

Renal Failure ◽

10.1080/0886022x.2020.1788581 ◽

2020 ◽

Vol 42 (1) ◽

pp. 638-645 ◽

Cited By ~ 2

Author(s):

Hai Wang ◽

Xiao Kang ◽

Yu Shi ◽

Zheng-hai Bai ◽

Jun-hua Lv ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Sofa Score ◽

Critically Ill Patients ◽

Kidney Injury ◽

Apache Ii ◽

Apache Ii Score

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Septic shock after liver transplantation successfully treated with endotoxin and cytokine adsorption continuous renal replacement therapy: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060520940439 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094043

Author(s):

Yining Li ◽

Linshan Zhou ◽

Lingzhi Yang ◽

Fang Yuan

Keyword(s):

Septic Shock ◽

Liver Transplantation ◽

Renal Replacement Therapy ◽

Liver Failure ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Chronic Liver ◽

Inflammatory Factors ◽

Decompensated Cirrhosis ◽

Chronic Liver Failure

Endotoxins and cytokines play an important role in multiple organ failure pathogenesis in patients with severe Gram-negative bacterial infection. We present a clinical case where an oXiris hemofilter was used for continuous renal replacement therapy (CRRT) treatment in a patient with septic shock after liver transplantation. A 35-year-old man with a 20-year history of hepatitis B presented with jaundice, loss of appetite, and decreased urine output. He was diagnosed with decompensated cirrhosis with acute-on-chronic liver failure, and liver transplantation was indicated. The day after surgery, he developed hyperthermia, hypotension, anuria, and a progressive increase in blood inflammatory markers and creatinine. Combined with the donor source and blood culture results, septic shock after transplantation was considered. The patient was immediately treated with endotoxin and cytokine adsorption CRRT (oXiris hemofilter) with tigecycline, caspofungin, and ganciclovir as anti-infectives. After 48 hours on CRRT, his blood pressure gradually stabilized, the CLIF Consortium Acute-on-Chronic Liver Failure score decreased from 63 to 43. Procalcitonin, endotoxin, and the inflammatory factors interleukin (IL)-6 and IL-10 also decreased gradually. The patient’s liver and kidney functions were completely restored. Our experience suggests that oXiris CRRT combined with antibacterial therapy is an effective treatment for septic shock after liver transplantation.

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