Two Cases of Acute Exacerbation of Interstitial Pneumonia Treated with Polymyxin B-immobilized Fiber Column Hemoperfusion Treatment

Noma, Satoshi; Matsuyama, Wataru; Mitsuyama, Hideo; Shioiri, Takayuki; Koreeda, Yoshimizu; Mizuno, Keiko; Higashimoto, Ikkou; Kakihana, Yasuyuki; Hashiguchi, Teruto; Maruyama, Ikuro; Osame, Mitsuhiro; Arimura, Kimiyoshi

doi:10.2169/internalmedicine.46.0117

Cited by 16 publications

(16 citation statements)

References 34 publications

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“…Five ventilated patients were weaned from the ventilation at one point. Our findings are consistent with other reports that have described the effectiveness of PMX-DHP for patients with AE-IP [18,19,21]. In addition to our assessment of oxygenation, we also assessed the systemic effect of PMX-DHP on rapidly progressive IP.…”

Section: Discussionsupporting

confidence: 89%

“…Other scoring systems could be useful to assess patients with IP; for example, the RIFLE score predicts the outcome of ARDS patients who undergo open lung biopsy [37]. The mortality rates for patients with rapidly progressive IP in 3 recent reports [18,19,21] were 33.3, 50 and 60%, respectively. The 30-day mortality rate in the present study was 36.3%, and the 90-day mortality rate was 51.6%.…”

Section: Discussionmentioning

confidence: 99%

“…Seo et al [18] have reported that IL-6, IL-8 and plasminogen activator inhibitor 1 are decreased in patients with rapidly progressive IP who responded to PMX-DHP. Noma et al [19] have reported that high mobility group box 1, MCP-1, IL-6 and IL-8 are reduced 72 h after PMX-DHP. Our results indicate that MCP-1 itself or MCP-1-producing cells including monocytes may be absorbed by PMX-DHP.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, novel effective therapies for these rapidly progressive and fatal lung diseases are needed. A few small study reports indicate that PMX-DHP could be a promising treatment candidate [18,19,20,21]. The effects, safety and applicability of PMX-DHP against rapidly progressive IP remain unknown.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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Background: Rapidly progressive interstitial pneumonia (IP), including acute exacerbation of IP, has a high mortality rate. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) was recently identified as an effective treatment for sepsis-associated acute respiratory distress syndrome. However, little is known about the effectiveness of PMX-DHP for rapidly progressive IP. Objectives: The present study investigates whether PMX-DHP is safe and effective against rapidly progressive IP. Methods: We retrospectively examined the effects of PMX-DHP in 33 consecutive patients with rapidly progressive IP who were resistant to steroid pulse therapy. Patients were hospitalized at Nagasaki University Hospital between 2006 and 2009. Results: Seventy-two hours after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127–153 mm Hg) had significantly improved. One week after PMX-DHP, the arterial oxygen tension/inspiratory oxygen fraction ratio (median 127–227 mm Hg), the alveolar-arterial difference of oxygen (median 371–177 mm Hg) and the number of positive criteria for systemic inflammatory response syndrome had significantly improved, despite the ineffectiveness of corticosteroid pulse therapy. The serum level of monocyte chemotactic protein 1 was significantly decreased immediately after PMX-DHP. Conclusions: PMX-DHP was safe and effective in improving oxygenation and systemic inflammatory response syndromein patients with rapidly progressive IP. The beneficialeffects of PMX-DHP may be at least partially due to the inhibition of monocyte activation.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…Although immunosuppressive therapy with cyclosporin A (CyA) (7,10) and polymyxin B-immobilized fiber column hemoperfusion treatment (18) has been reported to be effective to some extent, a sufficiently effective therapy has not yet been established. Some investigators even reported the sterility of intensive care unit and a ventilator for patients with AE-IPF, because the mortality of these patients approaches 100% (9,11,16,19).…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus and Steroid Treatment for Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Horita¹,

Akahane²,

Okada³

et al. 2011

Intern. Med.

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Objective Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) occurs during the chronic progressive course of idiopathic pulmonary fibrosis. Mortality is estimated to be >70%, because no effective treatment has been established. We evaluated the effectiveness of combination therapy of tacrolimus and methylprednisolone for AE-IPF. Methods Patients of AE-IPF treated with methylprednisolone pulse therapy with or without tacrolimus (targeting 20 ng/mL) during the period between January 2001 and April 2010 were retrospectively reviewed. The primary endpoints were survival rate and duration. We also observed lactate dehydrogenase levels, partial pressure of arterial oxygen/fraction of inspired oxygen ratio (P/F ratio), KL-6, occurrence of re-exacerbation, and computed tomography score. Results Fifteen Japanese patients [tacrolimus group aged 74.2±6.0 years old (n=5), non-tacrolimus group aged 75.1±12.8 years old (n=10)] were identified. Pre-treatment clinical parameters were not significantly different between the two groups. Four of 5 tacrolimus group patients and 1 of 10 non-tacrolimus group patients survived (p<0.05). The median survival durations were >92 days (tacrolimus group) and 38 days (nontacrolimus group) (p<0.05). Lactate dehydrogenase levels and the P/F ratio were also significantly favorable in the tacrolimus group. KL-6 and CT score were not significantly different in both groups. Four re-acute exacerbations were observed only in the non-tacrolimus group. Conclusion Combined tacrolimus and methylprednisolone pulse therapy mitigates AE-IPF, prevents re-acute exacerbation, and contributes to a better prognosis.

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Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock

Cruz

Antonelli²,

Fumagalli³

et al. 2009

JAMA

722

554

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EVERE SEPSIS AND SEPTIC SHOCK AREcommon problems in the intensive care unit (ICU) and carry a high mortality. Endotoxin, one of the principal components on the outer membrane of gram-negative bacteria, is considered relevant to their pathogenesis. High levels of endotoxin activity are associated with worse clinical outcomes. 1 However, effectiveness of endotoxintargeted therapy is still controversial. 2,3 Polymyxin B, an antibiotic with high affinity for endotoxin, has been bound and immobilized to polystyrene fibers in a medical device for hemoperfusion. This device can effectively bind endotoxin both in vitro and in vivo and could potentially interrupt the biological cascade of sepsis. 4 In a systematic review, 5 direct hemoperfusion with the See also p 2496 and Patient Page.

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Two Cases of Acute Exacerbation of Interstitial Pneumonia Treated with Polymyxin B-immobilized Fiber Column Hemoperfusion Treatment

Abstract: The effect of polymixin B-immobilized fiber column (PMX)

Cited by 16 publications

References 34 publications

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

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

Tacrolimus and Steroid Treatment for Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock

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