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Hemoperfusion With an Immobilized Polymyxin B Fiber Column Improves Tissue Oxygen Metabolism

:  Recently, direct hemoperfusion with a polymyxin B‐coated fiber column (DHP‐PMX) has been increasingly used for the treatment of sepsis, and an improvement in outcomes has been reported. However, the mechanism of the method is not known in detail. In the present study, we examined whether the perf...

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Published in:Therapeutic apheresis and dialysis 2006-10, Vol.10 (5), p.430-435
Main Authors: Kushi, Hidehiko, Miki, Takahiro, Nakahara, Jun, Okamoto, Kazuhiko, Kawahara, Yayoi, Saito, Takeshi, Tanjoh, Katsuhisa
Format: Article
Language:English
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Summary::  Recently, direct hemoperfusion with a polymyxin B‐coated fiber column (DHP‐PMX) has been increasingly used for the treatment of sepsis, and an improvement in outcomes has been reported. However, the mechanism of the method is not known in detail. In the present study, we examined whether the performance of DHP‐PMX improved tissue oxygen metabolism in patients with sepsis. Twenty‐two patients with sepsis, satisfying the following criteria, were enrolled in the study: (i) signs of systemic inflammatory response syndrome caused by infection; and (ii) mean arterial blood pressure ≥60 mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP‐PMX for appropriate intravenous infusion, and the DHP‐PMX was carried out twice within 24 h (for 3 h each time). Then, the gastric mucosal‐arterial PCO2 difference (PCO2 gap) was calculated as the gastric mucosal PCO2 minus arterial PCO2. A PCO2 gap ≥8 mm Hg was used to define abnormal tissue oxygen metabolism. PCO2 gap was measured before PMX‐DHP, as well as 24, 48, and 72 h afterward. PCO2 gap was 20 ± 4.9 mm Hg before DHP‐PMX vs. 16 ± 2.7 mm Hg (P = 0.189) at 24 h, 12 ± 2.8 mm Hg (P = 0.046) at 48 h, and 11 ± 2.2 mm Hg (P = 0.045) at 72 h afterward, showing a significant decrease from 48 h onward compared with before treatment. These findings suggest that DHP‐PMX improves tissue oxygen metabolism.
ISSN:1744-9979
1744-9987
DOI:10.1111/j.1744-9987.2006.00407.x