Korean J Crit Care Med.  2015 May;30(2):95-102. 10.4266/kjccm.2015.30.2.95.

Polymyxin B Immobilized Fiber Hemoperfusion in Refractory Intra-abdominal Septic Shock

• Chang HW
• Cho YJ
• Park SH
• Kim M

• KMID: 2227671
• DOI: http://doi.org/10.4266/kjccm.2015.30.2.95

Abstract

The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported. However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases of intra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatment improved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated with septic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractility assessed by echocardiography returned to baseline. In case 3, a patient with Burkitt's lymphoma and neutropenia was found to be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parameters improve after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was more significant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged from the hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients with refractory intra-abdominal infection associated with septic shock.

Keyword

hemoperfusion; intra-abdominal infection; polymyxin B; septic shock

MeSH Terms

Bacteremia
Burkitt Lymphoma
Cardiomyopathies
Colectomy
Echocardiography
Escherichia coli
Gastroenteritis
Hemodynamics
Hemoperfusion*
Humans
Intraabdominal Infections
Klebsiella pneumoniae
Lactic Acid
Mortality
Neutropenia
Peritonitis
Polymyxin B*
Resuscitation
Shock
Shock, Cardiogenic
Shock, Septic*
Lactic Acid
Polymyxin B

Figure

• 

  Fig. 1. Continuous renal replacement therapy machine connected to the Toraymyxin® cartridge (arrow) and tubing after flushing.

• 

  Fig. 2. Graphs show serial changes in the mean arterial blood pressure (MAP) and heart rate (HR) after polymyxin B immobilized fiber hemoperfusion (PMX) treatment.

• 

  Fig. 3. Graphs show the serial change in lactic acid and white blood cell count after polymyxin B immobilized fiber hemoperfusion (PMX) treatment.

Reference

References

1. Hanasawa K, Tani T, Oka T, Yoshioka T, Endo Y, Horisawa M, et al. A new treatment for endotoxemia with direct hemoperfusion by polymyxin immobilized fiber. 1984. Ther Apher. 2000; 4:142–5.

2. Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009; 301:2445–52.

3. Nakamura T, Ebihara I, Shoji H, Ushiyama C, Suzuki S, Koide H. Treatment with polymyxin B-immobilized fiber reduces platelet activation in septic shock patients: decrease in plasma levels of soluble P-selectin, platelet factor 4 and beta-thromboglobulin. Inflamm Res. 1999; 48:171–5.

4. Nemoto H, Nakamoto H, Okada H, Sugahara S, Moriwaki K, Arai M, et al. Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif. 2001; 19:361–8. discussion 368-9.

5. Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA, et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock. 2005; 23:400–5.

6. Iwagami M, Yasunaga H, Doi K, Horiguchi H, Fushimi K, Matsubara T, et al. Postoperative polymyxin B hemoperfusion and mortality in patients with abdominal septic shock: a propensity-matched analysis. Crit Care Med. 2014; 42:1187–93.

7. Zhou F, Peng Z, Murugan R, Kellum JA. Blood purification and mortality in sepsis: a meta-analysis of randomized trials. Crit Care Med. 2013; 41:2209–20.

8. Nord NM., Hoeprich PD. Polymyxin B and colistin. A critical comparison. N Engl J Med. 1964; 270:1030–5.

9. Klein DJ, Foster D, Schorr CA, Kazempour K, Walker PM, Dellinger RP. The EUPHRATES trial (Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic shock): study protocol for a randomized controlled trial. Trials. 2014; 15:218.

10. Nakamura T, Kawagoe Y, Matsuda T, Shoji H, Ueda Y, Tamura N, et al. Effect of polymyxin B-immobilized fiber on blood metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels in acute respiratory distress syndrome patients. Blood Purif. 2004; 22:256–60.

11. Takeyama N, Noguchi H, Hirakawa A, Kano H, Morino K, Obata T, et al. Japan Sepsis Study G. Time to initiation of treatment with polymyxin B cartridge hemoperfusion in septic shock patients. Blood Purif. 2012; 33:252–6.

12. Sakamoto Y, Mashiko K, Matsumoto H, Hara Y, Kutsukata N, Yamamoto Y. Relationship between effect of polymyxin B-immobilized fiber and high-mobility group box-1 protein in septic shock patients. ASAIO J. 2007; 53:324–8.

13. Ishizuka M, Tago K, Kubota K. Impact of prothrombin time-International Normalized Ratio on outcome of patients with septic shock receiving polymyxin B cartridge hemoperfusion. Surgery. 2014; 156:168–75.

14. Yamamoto H, Koizumi T, Kaneki T, Fujimoto K, Kubo K, Honda T. Direct hemoperfusion with polymyxin B-immobilized fiber improves shock and hypoxemia during endotoxemia in anesthetized sheep. J Endotoxin Res. 2002; 8:419–26.

15. Shimizu T, Obata T, Sonoda H, Akabori H, Tabata T, Eguchi Y, et al. The ability of endotoxin adsorption during a longer duration of direct hemoperfusion with a polymyxin B-immobilized fiber column in patients with septic shock. Transfus Apher Sci. 2013; 49:499–503.

16. Cruz DN, Perazella MA, Bellomo R, de Cal M, Polanco N, Corradi V, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Critic Care. 2007; 11:R47.

17. Sawa N, Ubara Y, Sumida K, Hiramatsu R, Hasegawa E, Yamanouchi M, et al. Direct hemoperfusion with a polymyxin B column versus vasopressin for gram negative septic shock: a matched cohort study of the effect on survival. Clin Nephrol. 2013; 79:463–70.

18. Tal S, Guller V, Goland S, Shimoni S, Gurevich A. Reversible myocardial dysfunction in septic shock. Isr Med Assoc J. 2013; 15:520–1.