Time to Initiation of Treatment with Polymyxin B Cartridge Hemoperfusion in Septic Shock Patients

Abstract

Background: We investigated whether early initiation of hemoperfusion with a polymyxin B cartridge (PMX) after the diagnosis of septic shock could improve the clinical outcome. Methods: A prospective, open-labeled, multicenter cohort study was performed at intensive care units in Japan. 41 patients received PMX within 6 h after the diagnosis of septic shock (early group) and 51 patients were treated after 6 h (late group). Results: The early group had a significantly shorter duration of ventilator support and also had a lower catecholamine requirement. PMX was effective for improvement of hypotension, hypoperfusion, the sequential organ failure assessment score, and pulmonary oxygenation regardless of the timing of its initiation. The 28-day mortality rate did not differ between the two groups. Conclusions: Early initiation of PMX shortened the duration of ventilator support and also reduced the catecholamine requirement, so early treatment of septic shock should achieve a better outcome.

New Trends in Polymyxin B Hemoperfusion: From 2006 to 2013

“…In a prospective, open-labeled, multicenter cohort study, 41 patients initiated PMX within 6 h of diagnosis of septic shock (early group) while 51 patients initiated treatment after 6 h (median 27 h; late group) [30]. Blood pressure, tissue perfusion, SOFA score and pulmonary oxygenation improved regardless of the timing of PMX initiation.…”

Exacerbation of prothrombin time-international normalized ratio before second polymyxin B cartridge hemoperfusion predicts poor outcome of patients with severe sepsis and/or septic shock

“…All of the data used for this study were collected by the Japan Sepsis Study Group to explore the hypothesis that PMX would prevent septic shock-induced organ dysfunction, and that early use of PMX would improve outcome. Approval to retrospectively re-analyze all of the prospectively collected data was granted by a representative of the Japan Sepsis Study Group [12]. Therefore, this study had a retrospective design.…”

“…A second PMX was performed 24 hours after the end of the first one. Nafamostat mesilate, low-molecular-weight heparin, or unfractionated heparin was used as the anticoagulant [12].…”

“…Similarly, if such CCs showed improvement in the interval before the second PMX, then a second PMX would be more likely to improve outcome. Ishizuka et al 6 On this basis, we explored the CCs showing the most significant change between the first and second PMX sessions, and associated with 28-day mortality, using data collected prospectively through multi-center collaboration [12] to clarify the indications for a second PMX session in patients with SS. …”

Looped Host Defense Peptide CLP-19 Binds to Microtubules and Inhibits Surface Expression of TLR4 on Mouse Macrophages

“…This interest has led to the characterization and isolation of numerous HDPs from animals, insects, plants, and even bacteria. For example, polymyxin B (9,10), bactericidal/permeability-increasing protein (11)(12)(13), , and mastoparan peptide (18) exhibit robust LPS-neutralizing activity in vitro and protection against lethal endotoxin shock in mouse models. Another HDP, the Limulus anti-LPS factor (LALF), which is a small basic protein from the arthropods Tachypleus tridentatus and Limulus polyphemus, is particularly attractive because it inhibits the endotoxin-mediated activation of the coagulation cascade by binding to LPS (19,20).…”