Acute respiratory distress syndrome caused by carbon monoxide poisoning and inhalation injury recovered after extracorporeal membrane oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column: a case report

Background Inhalation injury from smoke or chemical products and carbon monoxide poisoning are major causes of death in burn patients from fire accidents. Respiratory tract injuries from inhalation injury and carbon monoxide poisoning can lead to acute respiratory distress syndrome and cytokine storm syndrome. In the case of acute respiratory failure needing mechanical ventilation accompanied by cytokine storm, mortality is high and immediate adequate treatment at the emergency department is very important. Case presentation This report describes a case of acute respiratory distress syndrome and cytokine storm followed by carbon monoxide poisoning in a 34-year-old Korean male patient who was in a house fire, and was successfully treated by extracorporeal membrane oxygenation and direct hemoperfusion with polymyxin B-immobilized fiber column at emergency department. Conclusions To prevent mortality in acute respiratory distress syndrome with cytokine storm from inhalation injury and to promote a better prognosis, we suggest that early implication of extracorporeal membranous oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column even at the emergency department should be considered.

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

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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 (&#x3e;2 h of PMX-DHP). <b><i>Results:</i></b> Median MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (<i>p</i> &#x3c; 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 (<i>p</i> &#x3c; 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 &#x3c;8 h duration (<i>p</i> &#x3c; 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups. <b><i>Discussion/Conclusions:</i></b> 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.

Serum Lactate Dehydrogenase Level As a Predictor Of Survival For Patients With Acute Exacerbation of Idiopathic Interstitial Pneumonias Undergoing Polymyxin B-Immobilized Fiber Column-Direct Hemoperfusion

BackgroundAcute exacerbation of chronic fibrosing idiopathic interstitial pneumonias (AE-IIPs) is known to be associated with a poor prognosis. In Japan, polymyxin B-immobilized fiber column-direct hemoperfusion (PMX-DHP) therapy is often used along with corticosteroids for the treatment of patients with AE-IIPs. However, the serum marker that predicts treatment response to PMX-DHP is still unknown. Our aim was to evaluate the serum marker that predicts the outcome in patients with AE-IIPs undergoing PMX-DHP therapy.MethodsWe retrospectively collected the medical records of 104 patients who developed AE-IIPs for the first time and visited Juntendo University Hospital between April 2009 and July 2020. Among these patients, 33 patients who received PMX-DHP were identified. Among the patients who received PMX-DHP, 18 patients who survived for over 30 days since the initiation of PMX-DHP therapy were classified into the “survival group,” and 15 patients who succumbed to the condition in less than 30 days were categorized into the “non-survival group.” We evaluated data on the patients’ background, survival, and differences in the serum markers associated with AE-IIPs and in oxygenation markers between the groups.ResultsAmong patient characteristics, median forced vital capacity was significantly higher in the survival group than in the non-survival group. Among serum markers, 7 days after the initiation of PMX-DHP therapy, serum lactate dehydrogenase (LDH) levels, white blood cell counts, and D-dimer levels were significantly higher and serum lymphocyte count was significantly lower in the non-survival group than in the survival group. PaO2/FiO2 ratio (P/F ratio) and alveolar-arterial oxygen difference (Aa-DO2) were significantly different between the two groups. The changes in LDH level (ΔLDH), P/F ratio, and Aa-DO2 were significantly different from day 1 to 7 days after the initiation of PMX-DHP between the two groups. Multivariate analysis revealed that ΔLDH was the only risk factor associated with poor prognosis. The cut-off value of ΔLDH was calculated as −8. The median survival time (MST) was significantly longer in patients with low ΔLDH values (<−8) than in those with high ΔLDH values (>−8).ConclusionsChanges in serum LDH levels are reasonable markers for evaluating the prognosis of PMX-DHP therapy.