[Endotoxin eliminating therapy in patients with severe sepsis--direct hemoperfusion using polymyxin B immobilized fiber column].

BACKGROUND AND METHODS

PMX is a blood purifier containing chemically immobilized polymyxin B fiber (PMX-F). To evaluate its effectiveness on the severe septic human, direct hemoperfusion (DHP) using a PMX-F was performed for 2 hours. The changes in various circulatory parameters, symptoms of septic shock, and blood endotoxin concentration and the survival rate, were evaluated.

RESULTS

DHP was performed 61 times in 42 patients, of whom 38 had septic MOF, 25 with gram-negative bacterial infection. At the initiation of this treatment, 33 patients were receiving vasoactive agents, and 36 were under artificial ventilation via endotracheal intubation. The mean septic severity score (SSS) in all patients was about 46.6. Twenty-two of the 42 survived. The endotoxin concentration (mean +/- S.E.; pg/ml) was 85.0 +/- 27.2 immediately before treatment but significantly decreased to 57.5 +/- 28.4 after treatment (n = 50) and to 28.2 +/- 4.4 on the next day (n = 23) (p < 0.01). The endotoxin concentrations at the inlet and outlet of the PMX also significantly decreased 30 minutes after the initiation of DHP. Circulatory parameters, BP, CI, SVR and Vo2I demonstrated significant improvement. Body temperature also showed the same results. The removal of endotoxin in the blood using PMX was effective for severe sepsis or septic MOF. Various symptoms due to endotoxin was alleviated after this treatment.