Direct hemoperfusion with polymyxin B-immobilized fiber improves shock and hypoxemia during endotoxemia in anesthetized sheep

Abstract

This study evaluates the effect of direct hemoperfusion (DHP) using polymyxin B-immobilized fibers (PMX-F) as an extracorporeal blood filter on systemic hypotension and lung injury during endotoxemia Sheep were anesthetized, intubated, mechanically ventilated with 50% oxygen and connected to the DHP system between the right femoral artery and left jugular vein. Group 1 (n = 6)sheep were infused with 10 microg/kg Escherichia coli endotoxin over a 30 min period. At the same time, sheep underwent DHP with PMX-F (Toraymyxin: PMX-20R) for 2 h at a flow rate of 60 ml/h. Group 2 (n = 6) sheep were infused with the same dose of endotoxin and treated with a sham column, in the same manner as those in group 1. DHP with PMX-F significantly improved and restored systemic pressure and arterial oxygen tension in group 1 sheep, although these values never returned to the baseline levels of group 2 sheep. Pulmonary hypertension and leukocytopenia were observed after endotoxin infusion in both groups, but there were no significant differences between these values. DHP with PMX-F significantly decreased the elevation of plasma nitric oxide products. The treatment with PMX-F improves shock and deteriorated oxygenation during endotoxemia, probably through the suppression of nitric oxide production.

Beneficial Effect of Polymyxin B-immobilized Fiber Column (PMX) Hemoperfusion Treatment on Acute Exacerbation of Idiopathic Pulmonary Fibrosis

“…Acute exacerbations of IPF have been described high mortality in several reports (4,5,7,18 (10). In an animal model of sepsis, PMX has been reported to improve oxygenation through suppression of nitric oxide production (19 (8). Additionally, PMX treatment once or twice for 4 hours has reportedly improved the survival of sepsis patients (13).…”

Neutrophil Adsorption by Polymyxin B-Immobilized Fiber Column for Acute Exacerbation in Patients with Interstitial Pneumonia: A Pilot Study

“…Aoki et al [11] suggested that the reduction of endotoxin concentration by PMX might reduce pulmonary vasoconstriction and intrapulmonary shunting and increase the arterial oxygen tension (PaO 2 )/inspiratory oxygen fraction (FiO 2 ) (P/F) ratio in sepsis and septic shock. Yamamoto et al [22] showed that PMX significantly decreased intrapulmonary shunt and improved deteriorated oxygenation during endotoxemia in anesthetized sheep. However, since in the present study blood endotoxin levels in IP patients with acute exacerbation were all below the level of detection ( !…”

Rapidly Progressive Interstitial Pneumonia Associated with Clinically Amyopathic Dermatomyositis Successfully Treated with Polymyxin B-immobilized Fiber Column Hemoperfusion

“…However, PMX is effective against both gram-negative and gram-positive sepsis (17 (15). In an animal model of sepsis, PMX improves oxygenation through the suppression of nitric oxide production (21). Kushi (26).…”