Effects of PMX‐DHP Treatment for Patients With Directly Induced Acute Respiratory Distress Syndrome

Abstract

Endotoxin-removal direct hemoperfusion column containing polymyxin B immobilized fibers (PMX-DHP) is an effective procedure for the treatment of sepsis-induced acute respiratory distress syndrome (ARDS). We investigated retrospectively the effects and appropriate timing of PMX-DHP induction for directly induced ARDS in 38 patients. PMX-DHP was carried out twice for two hours. Blood pressure, heart rate (HR) and PaO(2)/FIO(2) (PF) ratio, leukocytes, platelets, endotoxin, inflammatory cytokines and clusters of differentiated peripheral neutrophils and monocytes were measured before and after PMX-DHP. Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sequential Organ Failure Assessment (SOFA) scores and lung injury scores (LIS) were determined at the time of starting PMX-DHP. The underlying causes of ARDS were pneumonia in 29 patients and aspiration pneumonia in 9 patients. The patients were divided into Survivors (n = 21) and Nonsurvivors (n = 17). Mortality was 45% at 30 days after PMX-DHP. The APACHE II and SOFA scores and the LIS were not significantly different between the two groups. The time from the onset of ARDS to the start of PMX-DHP was significantly delayed between the two groups. PMX-DHP significantly improved the PF ratio, HR and systolic blood pressure in the Survivors compared to the Nonsurvivors. The function of active monocytes in the peripheral blood was significantly suppressed after PMX-DHP. This early induction of PMX-DHP is indicated for directly induced ARDS. In the Nonsurvivors, this delay could have led to undesirable responses to oxygenation and circulation after PMX-DHP.

Direct Hemoperfusion Using Immobilized Polymyxin B in Patients with Rapidly Progressive Interstitial Pneumonias: A Retrospective Study

“…A recent multi-center randomized controlled trial confirmed that PMX-DHP is more effective than conventional therapy in patients with sepsis [2] and indicated that PMX-DHP might favorably affect endotoxin levels, arterial blood pressure, vasopressor requirement, the arterial oxygen tension (PaO 2 )/inspiratory oxygen fraction (FiO 2 ) ratio (P/F) and mortality. Studies have also found that PMX-DHP is helpful for patients with complicated acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), which is pathologically characterized by diffuse alveolar damage (DAD) [3,4,5,6]. DAD is also evident in some patients with rapidly progressive interstitial pneumonia (IP).…”

Evaluation of Different Perfusion Durations in Direct Hemoperfusion with Polymyxin B-Immobilized Fiber Column Therapy for Acute Exacerbation of Interstitial Pneumonias

“…More recently, PMX-DHP has been shown to be an efficacious therapy for acute lung injury/acute respiratory distress syndrome despite their etiology [13,14,15,16]. Interestingly, several recent studies have demonstrated the possibility that PMX-DHP is also useful for the treatment of AE-IP [17,18,19,20].…”

Diffuse Alveolar Hemorrhage following Itraconazole Injection

“…(Fig. 3) (12) and other recent studies have also proved that PMX treatment improves the PaO2/ FiO2 ratio (13) and suppresses the function of activated monocytes in the peripheral blood of ARDS patients (14). Further accumulation of clinical data is warranted for the evaluation of PMX treatment.…”