Polymyxin B‐immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome

Maede, Yoshinobu; Ibara, Satoshi; Tokuhisa, Takuya; Ishihara, Chie; Hirakawa, Eiji; Matsui, Tatsunosuke; Takahashi, Daijiro; Machigashira, Seiro; Minakami, Hisanori

doi:10.1111/ped.13006

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…Although the characteristics and responses of neonatal sepsis differ from those of adults [5], PMX-HP reduced levels of immune mediators such as interleukin-6, highly mobile group-1 box protein, or interferon gamma in neonatal sepsis model [6], as in adult studies [3,7]. However, polymyxin Bimmobilized fiber cartridges for children as well as neonates are not available in most countries except Japan, and a few reports on its use in neonates have been found in the literature [8,9]. Here, we report a case of the successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with carbapenem resistant Acinetobacter baumannii (CRAB) septic shock, who was on extracorporeal membrane oxygenation (ECMO) support.…”

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confidence: 99%

A Successful Application of Adult Polymyxin B-Immobilized Fiber Column Hemoperfusion to a Neonate with Septic Shock

Kim

et al. 2019

Acute Crit Care

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Direct hemoperfusion therapy with a polymyxin B-immobilized fiber column (PMX-HP) has been introduced as a therapeutic option for gram negative bacterial septic shock in adults. However, its use in neonates and children has not yet been established. We successfully performed hemoperfusion therapy using an adult polymyxin B-immobilized fiber column in a neonate with carbapenem resistant Acinetobacter baumannii septic shock. The application was technically feasible because the neonate was on extracorporeal membrane oxygenation (ECMO). Although it did not rescue the patient, there was significant short-lasting improvement in pulmonary oxygenation and hemodynamics, leading to wean the patient from ECMO. PMX-HP could be used as an adjunctive treatment for selected neonatal and pediatric patients with gram negative bacterial septic shock.

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confidence: 99%

A Successful Application of Adult Polymyxin B-Immobilized Fiber Column Hemoperfusion to a Neonate with Septic Shock

Kim

et al. 2019

Acute Crit Care

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“…For example, in Japan, there are three sizes of PMX column: PMX-20R, PMX-05R, and PMX-01R, with blood volumes 135, 40, and 8 mL, respectively. The PMX-05R was used to treat sepsis in 10 children 9–48 months old ( 19 ), and PMX-01R was used in preterm infants ( 20 , 21 ). There were no reports of treatment complications.…”

Section: Discussionmentioning

confidence: 99%

“…There are also reports of use of PMX-DHP being associated with improvement in pulmonary function, such as the P o 2 -to-F io 2 ratio in adults (9) and the arterial-to-alveolar P o 2 ratio in neonates (21). In this regard, use of PMX-DHP is associated with improvement in oxygenation in patients with sepsis and various lung diseases (22–25).…”

Section: Discussionmentioning

confidence: 99%

Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series

Saetang¹,

Samransamruajkit²,

Singjam³

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: To evaluate the use of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) as adjunctive therapy during pediatric patients with septic shock. DESIGN: Prospective observational study. SETTING: Nine-bed PICUs at university referral hospital. PATIENTS: Children (30 d to 15 yr) with septic shock and Pediatric Logistic Organ Dysfunction (PELOD)-2 score greater than or equal to 10 or Pediatric Risk of Mortality (PRISM) 3 score greater than or equal to 15, who were also receiving at least one inotrope. INTERVENTION: Patients received 2–4 hour treatment with PMX-DHP 20R column on 2 consecutive days. MEASUREMENTS AND MAIN RESULTS: We enrolled six children aged 21–167 months old (median, 99-mo old), with a body weight of 10–50 kg (median, 28 kg). All six patients had both PELOD-2 greater than or equal to 10 and PRISM-3 greater than or equal to 15, required invasive mechanical ventilation, and received standard treatment for septic shock before enrollment. We observed significant improvement in PELOD-2 score from baseline to 72 hours after the start of PMX-DHP (mean [95% CI] from 14.3 [12.2–16.5] to 6.0 [0.3–11.7]; p = 0.006). The vasoactive inotropic score (VIS) and lactate concentration also significantly decreased from baseline to 72 hours (VIS, 60 mmol/L [25–95 mmol/L] to 4.0 mmol/L [44.1–12 mmol/L]; p = 0.003; lactate, 2.4 mmol/L [1.0–3.8 mmol/L] to 1.0 mmol/L [0.5–1.5 mmol/L]; p = 0.01). Five of six patients survived. There was no device-related adverse event in these patients. CONCLUSIONS: In this case series of treatment with PMX-DHP as adjunctive therapy in children with refractory septic shock and high baseline severity, we have shown that patient recruitment is feasible. We have also found that clinical hemodynamic and severity of illness scores at 72 hours may be potential end points for testing in future randomized controlled trials.

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“…Endotoxin triggers a signaling cascade for leukocytes, macrophages, and endothelial cells to secrete various mediators including cytokines, leading to septic shock. Maeda et al [5] have shown that PMX-DHP treatment decreased the interleukin-6 level from ≥1,000 pg/mL to <500 pg/mL in 8 premature infants with systemic inflammatory response syndrome. Nishizaki and colleagues [1] reported in the letter to the editor that prognosis of septic neonates in earlier PMX-DHP induction was better than that in later PMX-DHP induction.…”

mentioning

confidence: 99%

Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion for Micro-Preemie Infants with Septic Shock. Is Extended Duration Better than Early Start? Comment to the Letter to the Editor of Nishizaki and Colleagues

2021

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Polymyxin B‐immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome

Abstract: Active treatment with PMX-DHP and CHDF was helpful in the reduction of days on inhaled oxygen and tracheal intubation in preterm SIRS infants with hypercytokinemia. Further prospective randomized studies are warranted.

Cited by 8 publications

References 29 publications

A Successful Application of Adult Polymyxin B-Immobilized Fiber Column Hemoperfusion to a Neonate with Septic Shock

A Successful Application of Adult Polymyxin B-Immobilized Fiber Column Hemoperfusion to a Neonate with Septic Shock

Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series

Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion for Micro-Preemie Infants with Septic Shock. Is Extended Duration Better than Early Start? Comment to the Letter to the Editor of Nishizaki and Colleagues

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