Acute Crit Care.  2020 Nov;35(4):302-306. 10.4266/acc.2020.00038.

Direct hemoperfusion with polymyxin B-immobilized fiber column in a patient with acute exacerbation of idiopathic pulmonary fibrosis

• Kim SY
• Park JH
• Kim HJ
• Jang HJ
• Kim HK
• Kim SH
• Lee JH

• KMID: 2510551
• DOI: http://doi.org/10.4266/acc.2020.00038

Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease characterized by dyspnea and a worsening of the lung function. Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are defined by a clinically significant respiratory deterioration, that typically develops in less than 1 month, accompanied by new radiologic abnormalities on high-resolution computed tomography, including diffused and bilateral ground-glass opacification, along with an absence of other obvious clinical etiologies. Recently, AE-IPF has gained significant importance as a major cause of mortality and morbidity. However, despite the extremely poor prognosis of the condition, no well-validated therapeutic interventions are currently available. Therefore, novel treatment modalities are being investigated and applied in addition to conventional treatments. Among them, several studies have reported that a direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP), developed for endotoxin removal in septic shock, has an effect on AE-IPF. We describe two cases of PMX-DHP treatment with conflicting results. One patient successfully recovered via a PMX-DHP in severe AE-IPF that required extracorporeal membrane oxygenation (ECMO). PMX-DHP subsequently improved oxygenation (PaO2/FiO2 ratio) and decreased the levels of inflammatory markers (interleukin-6, C-reactive protein, and white blood cells). The patient dramatically recovered without the need for ECMO. PMX-DHP may be considered an alternative therapy in AE-IPF patients requiring mechanical ventilation or ECMO.

Keyword

idiopathic pulmonary fibrosis; polymyxin B; prognosis

Figure

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  Figure 1. Chest X-rays a month before the hospital visit (A) and on emergency room visit (B). (A) Chest X-ray showing reticular opacities in both lower lung fields. (B) Chest X-ray showing an increased infiltration in both lower lung fields.

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  Figure 2. Chest computed tomography findings before (A) and after (B) direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) treatment. A chest computed tomography after two cycles of PMX-DHP demonstrates improvements in the ground-glass opacification around underlying honeycombing.

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  Figure 3. The PaO2/FiO2 ratio (A), interleukin-6 (IL-6) level (B), and C-reactive protein (CRP) level (C) before and after direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP).

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