在重症铜绿假单胞菌肺炎猪模型中使用多粘菌素B固定化柱进行直接血液灌流的效果。

The effects of direct hemoperfusion using a polymyxin B-immobilized column in a pig model of severe Pseudomonas aeruginosa pneumonia.

作者信息

Li Bassi Gianluigi, Marti Joan Daniel, Xiol Eli Aguilera, Comaru Talitha, De Rosa Francesca, Rigol Montserrat, Terraneo Silvia, Rinaudo Mariano, Fernandez Laia, Ferrer Miguel, Torres Antoni

机构信息

Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.

Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

出版信息

Ann Intensive Care. 2016 Dec;6(1):58. doi: 10.1186/s13613-016-0155-3. Epub 2016 Jul 5.

DOI:10.1186/s13613-016-0155-3

PMID:27378201

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4932027/

Abstract

BACKGROUND

Hemoperfusion through a column containing polymyxin B-immobilized fiber (PMX-HP) is beneficial in abdominal sepsis. We assessed the effects of PMX-HP in a model of severe Pseudomonas aeruginosa pneumonia.

METHODS

Eighteen pigs with severe P. aeruginosa pneumonia were mechanically ventilated for 76 h. Pigs were randomized to receive standard treatment with fluids and vasoactive drugs, or standard treatment with two 3-h PMX-HP sessions. Antibiotics against P. aeruginosa were never administered. We assessed endotoxemia through the endotoxin activity assay (EA). We measured the static lung elastance, ratio of arterial partial pressure per inspiratory fraction of oxygen (PaO2/FIO2), mean arterial pressure, cardiac output, systemic vascular resistance and inotropic score. Finally, every 24 h, we assessed complete blood count.

RESULTS

In comparison with the control group, PMX-HP decreased percentage of circulating neutrophils from 47.4 ± 13.8 to 40.8 ± 11.5 % (p = 0.009). In a subgroup of animals with the worst hemodynamic impairment, EA in the control and PMX-HP groups was 0.50 ± 0.29 and 0.29 ± 0.14, respectively (p = 0.018). Additionally, in the control and PMX-HP groups, static lung elastance was 26.9 ± 8.7 and 25.3 ± 7.5 cm H2O/L (p = 0.558), PaO2/FIO2 was 347.3 ± 61.9 and 356.4 ± 84.0 mmHg (p = 0.118), mean arterial pressure was 81.2 ± 10.3 and 81.6 ± 13.1 mmHg (p = 0.960), cardiac output was 3.30 ± 1.11 and 3.28 ± 1.19 L/min (p = 0.535), systemic vascular resistance was 1982.6 ± 608.4 and 2011.8 ± 750.0 dyne/s/cm(-5) (p = 0.939), and inotropic score was 0.25 ± 0.10 and 0.26 ± 0.18 (p = 0.864).

CONCLUSIONS

In mechanically ventilated pigs with severe P. aeruginosa pneumonia, PMX-HP does not have any valuable clinical benefit, and studies are warranted to fully evaluate a potential role of PMX-HP in septic shock associated with severe pulmonary infections.

摘要

背景

通过含有多粘菌素B固定纤维的柱体进行血液灌流（PMX-HP）对腹部脓毒症有益。我们评估了PMX-HP在严重铜绿假单胞菌肺炎模型中的作用。

方法

18只患有严重铜绿假单胞菌肺炎的猪接受机械通气76小时。猪被随机分为接受液体和血管活性药物的标准治疗，或接受两次3小时PMX-HP治疗的标准治疗。从未给予抗铜绿假单胞菌的抗生素。我们通过内毒素活性测定（EA）评估内毒素血症。我们测量了静态肺弹性、每吸入氧分数的动脉分压比值（PaO2/FIO2）、平均动脉压、心输出量、全身血管阻力和肌力评分。最后，每24小时评估一次全血细胞计数。

结果

与对照组相比，PMX-HP使循环中性粒细胞百分比从47.4±13.8降至40.8±11.5%（p = 0.009）。在血流动力学损害最严重的动物亚组中，对照组和PMX-HP组的EA分别为0.50±0.29和0.29±0.14（p = 0.018）。此外，在对照组和PMX-HP组中，静态肺弹性分别为26.9±8.7和25.3±7.5 cm H2O/L（p = 0.558），PaO2/FIO2分别为347.3±61.9和356.4±84.0 mmHg（p = 0.118），平均动脉压分别为81.2±10.3和81.6±13.1 mmHg（p = 0.960），心输出量分别为3.30±1.11和3.28±1.19 L/min（p = 0.535），全身血管阻力分别为1982.6±608.4和2011.8±750.0 dyne/s/cm(-5)（p = 0.939），肌力评分为0.25±0.10和0.26±0.18（p = 0.864）。