Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation

Crit Care. 2005;9(6):R653-61. doi: 10.1186/cc3815. Epub 2005 Oct 11.

Abstract

Introduction: The objective of this study was to clarify the efficacy and mechanism of action of direct hemoperfusion with an immobilized polymyxin B fiber column (DHP-PMX) in patients with acute lung injury or acute respiratory distress syndrome caused by sepsis.

Method: Thirty-six patients with sepsis were included. In each patient a thermodilution catheter was inserted, and the oxygen delivery index and oxygen consumption index were measured. DHP-PMX was performed in patients with a normal oxygen delivery index and oxygen consumption index (> 500 ml/minute per m2 and > 120 ml/minute per m2, respectively). The Acute Physiology and Chronic Health Evaluation II score was used as an index of the severity of sepsis, and survival was assessed after 1 month. The humoral mediators measured were the chemokine IL-8, plasminogen activator inhibitor-1, and neutrophil elastase (NE). These mediators were measured before DHP-PMX treatment, and at 24, 48, and 78 hours after the start of treatment. The arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was measured before DHP-PMX treatment and at 24, 48, 72, 92, and 120 hours after the start of treatment.

Results: All patients remained alive after 1 month. Before DHP-PMX treatment, the Acute Physiology and Chronic Health Evaluation II score was 24 +/- 2.0, the IL-8 level was 54 +/- 15.8 pg/ml, plasminogen activator inhibitor-1 was 133 +/- 28.1 ng/ml, and NE was 418 +/- 72.1 mug/l. These three humoral mediators began to decrease from 24 hours after DHP-PMX treatment, and the decline became significant from 48 hours onward. The PaO2/FiO2 ratio was 244 +/- 26.3 before DHP-PMX treatment but improved significantly from 96 hours onward. There were significant negative correlations between the PaO2/FiO2 ratio and blood levels of NE and IL-8.

Conclusion: The mechanism of action of DHP-PMX is still not fully understood, but we report the following findings. The mean blood levels of plasminogen activator inhibitor-1, NE, and IL-8 were significantly decreased from 48 hours after DHP-PMX treatment. The mean PaO2/FiO2 ratio was significantly improved from 96 hours after DHP-PMX treatment. Improvement in the PaO2/FiO2 ratio appeared to be related to the decreases in blood NE and IL-8 levels.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Biomarkers / blood
  • Endothelial Cells / metabolism
  • Female
  • Hemoperfusion / instrumentation*
  • Hemoperfusion / methods*
  • Humans
  • Interleukin-8 / blood
  • Leukocyte Elastase / blood
  • Male
  • Middle Aged
  • Oxygen / metabolism
  • Plasminogen Activator Inhibitor 1 / blood
  • Polymyxin B / therapeutic use*
  • Respiratory Distress Syndrome, Adult / etiology*
  • Respiratory Distress Syndrome, Adult / immunology
  • Respiratory Distress Syndrome, Adult / metabolism
  • Respiratory Distress Syndrome, Adult / therapy*
  • Sepsis / complications*
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Biomarkers
  • Interleukin-8
  • Plasminogen Activator Inhibitor 1
  • Leukocyte Elastase
  • Polymyxin B
  • Oxygen