Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 6/2005

Open Access 01-12-2005 | Research

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

Authors: Hidehiko Kushi, Takahiro Miki, Kazuhiko Okamaoto, Jun Nakahara, Takeshi Saito, Katsuhisa Tanjoh

Published in: Critical Care | Issue 6/2005

Login to get access

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 μg/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.
Appendix
Available only for authorised users
Literature
1.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Conensus Conference Committee. American College of Chest Physicans/Society of Critical Care Medicine. Chest 1992, 101: 1644-1655.CrossRefPubMed
2.
Zimmerman JE, Knaus WA, Wagner DP, Sun X, Hakim RB, Nystrom PO: A comparison of risks and outcome for patients with organ system failure: 1982-1990. Crit Care Med 1996, 24: 1633-1641. 10.1097/00003246-199610000-00006CrossRefPubMed
3.
Ziegler EJ, Fisher CJ Jnr, Sprung CL, Staraube RC, Sadoff JC, Foulke GE, Wortel CH, Fink MP, Dellinger RP, Teng NNH, et al.: Treatment of gram-negative bacteremia and shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group. N Engl J Med 1991, 324: 429-436.CrossRefPubMed
4.
Greenman RL, Schein RMH, Martin MA, Wenzel RP, Macintyre NR, Emmanuel G, Chmel H, Kohler RB, McCarthy M, Plouffe J, et al.: A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. The XOMA Sepsis Study Group. JAMA 1991, 266: 1097-1102. 10.1001/jama.266.8.1097CrossRefPubMed
5.
Quezado ZMN, Banks SM, Natanson C: New strategies for combating sepsis: the magic bullets missed the mark ... but the search continues. Trends Biotechnol 1995, 13: 56-63. 10.1016/S0167-7799(00)88906-4CrossRefPubMed
6.
Jaber BL, Barrett TW, Cendoroglo Neto M, Sundaram S, King AJ, Pereira BJ: Removal of cytokine inducing substances by polymyxin-B immobilized polystyrene-derivative fibers during in vitro hemoperfusion of 10% human plasma containing Staphylococcus aureus challenge. ASAIO J 1998, 44: 48-53.CrossRefPubMed
7.
Hanasawa K, Tani T, Kodama M: New approach to endotoxin and septic shock by means of polymyxin B immobilized fiber. Surg Gynecol Obstet 1989, 168: 323-331.PubMed
8.
Vincent JL, Laterre PF, Cohen J, Burchardi H, Bruining H, Lerma FA, Wittebole X, Backer D, Brett S, Marzo D, 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: 400-405. 10.1097/01.shk.0000159930.87737.8aCrossRefPubMed
9.
Tani T, Hanasawa K, Kodama M, Imaizumi H, Yonekawa M, Saito M, Ikeda T, Yagi Y, Takayama K, Amano I, et al.: Correlation between plasma endotoxin, plasma cytokines, and plasminogen activator inhibitor-1 in septic patients. World J Surg 2001, 25: 660-668. 10.1007/s002680020028CrossRefPubMed
10.
Ikeda T: Hemoadsorption in critical care. Ther Apher 2002, 6: 189-192. 10.1046/j.1526-0968.2002.00430.xCrossRefPubMed
11.
Todoroki H, Higure A, Nagata T, Okamoto K, Nagata N, Itoh H: Two cases of severe sepsis treated by operation and endotoxin eliminating therapy. Jpn J Gastroenterol Surg 1996, 29: 2319-2323.CrossRef
12.
Tsushima K, Kubo K, Koizumi T, Yamamoto H, Fujimoto K, Hora K, Kan-Nou Y: Direct hemoperfusion using a polymyxin B immobilized column improves acute respiratory distress syndrome. J Clin Apher 2002, 17: 97-102. 10.1002/jca.10019CrossRefPubMed
13.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994, 149: 818-824.CrossRefPubMed
14.
Hudson L, Steinberg KP: Epidemiology of acute lung injury and ARDS. Chest 1999,116(1 Suppl):74S-82S.CrossRefPubMed
15.
Moss M, Gillespie M, Ackerson L, Moore FA, Moore EE, Parsons PE: Endothelial cell activity varies in patients at risk for the adult respiratory distress syndrome. Crit Care Med 1996, 24: 1782-1786. 10.1097/00003246-199611000-00004CrossRefPubMed
16.
Ware LB: The acute respiratory distress syndrome. N Engl J Med 2000, 342: 1334-1349. 10.1056/NEJM200005043421806CrossRefPubMed
17.
Ducek SM, Garcia JG: Cytoskeletal regulation of pulmonary vascular permeability. J Appl Physiol 2001, 91: 1487-1500.
18.
Pober JS, Cotran RS: Cytokine and endothelial cell biology. Physiol Rev 1990, 70: 427-451.PubMed
19.
Knaus WA, Draper EA, Wanger DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818-829.CrossRefPubMed
20.
ARDS network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801CrossRef
21.
Ikeda T, Ikeda K, Nagura M, Taniguchi H, Matsushita M, Kiuchi S, Kuroki Y, Suzuki N, Matsuno N: Clinical evalusion of DHP-PMX for hypercytokinemia caused by septic multiple organ failure. Ther Apher Dial 2004, 8: 293-298. 10.1111/j.1526-0968.2004.00167.xCrossRefPubMed
22.
Nemoto H, Nakamoto H, Okada H, Sugahara S, Moriwaki K, Arai M, Kanno Y, Suzuki H: Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif 2001, 19: 361-369. 10.1159/000046966CrossRefPubMed
23.
Uriu K, Osajima A, Kamochi M, Watanabe H, Aibara K, Kaizu K: The severity of hyperdynamic circulation may predict the effects of direct hemoperfusion with the adsorbent column using polymyxin B-immobilized fiber in patients with gram-negative septic shock. Ther Apher 2001, 5: 25-30. 10.1046/j.1526-0968.2001.005001025.xCrossRefPubMed
24.
Gils A, Declerck PJ: Structure-function relationships in serpins: current concepts and controversies. Thromb Haemost 1998, 80: 531-541.PubMed
25.
Gadek JE, Fells GA, Wright DG, Crystal RG: Human neutrophil elastase functions as a type III collagen "collagenase". Biochem Biophys Res Commun 1980, 95: 1815-1822. 10.1016/S0006-291X(80)80110-0CrossRefPubMed
26.
Janoff A: Elastase in tissue injury. Ann Rev Med 1985, 36: 207-216. 10.1146/annurev.me.36.020185.001231CrossRefPubMed
27.
Kushi H, Nakahara J, Miki T, Okamoto K, Saito T, Tanjoh K: Hemoperfusion with an immobilized polymyxin B fiber column inhibits activation of vascular endothelial cells. Ther Apher Dial 2005, 9: 303-307. 10.1111/j.1744-9987.2005.00286.xCrossRefPubMed
28.
Van Damme J, Van Beeumen J, Opdenakker G, Billiau A: A novel, NH2-terminal sequence-characterized human monokine possessing neutrophil chemotactic, skin-reactive, and granulocytosis-promoting activity. J Exp Med 1988, 167: 1364-1376. 10.1084/jem.167.4.1364CrossRefPubMed
29.
Baggiolini M, Walz A, Kunkel SL: Neutrophil-activating peptide-1/interleukin-8, a novel cytokine that activates neutrophils. J Clin Invest 1989, 84: 1045-1049.PubMedCentralCrossRefPubMed
30.
Sato T, Shoji H, Koga N: Endotoxin absorption by polymyxin B immobilized fiber column in patients with systemic inflammatory response syndrome: the Japanese experience. Ther Apher Dial 2003, 7: 252-258. 10.1046/j.1526-0968.2003.00006.xCrossRefPubMed
31.
Kushi H, Saito T, Makino K, Hayashi N: IL-8 is a key mediator of neuroinflammation in severe traumatic brain injuries. Acta Neurochir Suppl 2003, 86: 347-350.PubMed
32.
Parsons P, Eisner M, Thompson T, Matthay M, Ancukiewicz M, Bernard G, Wheeler A, the NHLBI Acute Respiratory Distress Syndrome Clinical Trials Network: Low tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury. Crit Care Med 2005, 33: 1-6. 10.1097/01.CCM.0000149854.61192.DCCrossRefPubMed
33.
Jorens PG, Van Damme J, DeBacker W, Bossaert L, De Jongh RF, Herman AG, Rampart M: Interleukin 8 (IL-8) in the bronchoalveolar lavage fluid from patients with the adult respiratory distress syndrome (ARDS) and patients at risk for ARDS. Cytokine 1992, 4: 592-597. 10.1016/1043-4666(92)90025-MCrossRefPubMed
Metadata
Title
Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation
Authors
Hidehiko Kushi
Takahiro Miki
Kazuhiko Okamaoto
Jun Nakahara
Takeshi Saito
Katsuhisa Tanjoh
Publication date
01-12-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3815

Other articles of this Issue 6/2005

Critical Care 6/2005 Go to the issue

Research

The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study

Letter

Role of cardiac troponin as a prognosticator in critically ill patients

Journal club critique

Hydrocortisone infusion may improve survival in patients with severe community-acquired pneumonia

Commentary

Goal directed therapy: how long can we wait?

Commentary

Antithrombin in sepsis revisited

Research

Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study