Effects of hemoperfusion with an immobilized polymyxin-B fiber column on cytokine plasma levels in patients with abdominal sepsis.

AIM: The beneficial role of hemofiltration with immobilized polymyxin-B fiber (PMX) columns in sepsis, especially sepsis due to gram-negative bacteria, has previously been emphasized. Although the efficacy of PMX-B fiber-mediated hemofiltration in reducing plasma levels of cytokines has been reported, other studies did not confirm this observation. Here we report the effects of PMX-B fiber-mediated hemofiltration on outcome and cytokine plasma levels in patients with abdominal sepsis. METHODS: Twelve consecutive patients admitted to the Intensive Care Unit (October 2006-December 2007) for severe sepsis/septic shock from abdominal infection were treated with standard therapy and 2 cycles of hemofiltration with PMX cartridges. Clinical data and plasma levels of IL-6, IL-10 and TNF-a were measured 24 hours before and after PMX treatment. RESULTS: Plasma concentrations (pg/mL) of IL-6, IL-10 and TNF-a were significantly lower after hemofiltration with a PMX fiber column (279.9+/-69.2 vs. 130.9+/-18.4, 166.4+/-36.7 vs. 45.5+/-12.2, 83.1+/-13.5 vs. 23.9+/-5.1 pg/mL, respectively; P<0.05). After treatment, patients required lower doses of norepinephrine (0.3+/-0.1 vs. 0.8+/-0.1 mg/kg/min) and reduced lactate levels, recovery of respiratory function and improved Simplified Organ Failure Assessment (SOFA) scores. After 28 days, 6 patients (50%) had survived. Subgroup analysis demonstrated that survivors had higher IL-6 and lower IL-10 and TNF-a pre-treatment plasma levels (pg/mL) compared with deceased patients (324.4+/-41.1 vs.235.3+/-38.4; 98.5+/-16.1 vs. 234.3+/-48.6, 44.5+/-9.0 vs.121.6+/-52.3 pg/mL, respectively; P<0.05). No adverse events imputable to the treatment were recorded. CONCLUSION: Hemofiltration with a PMX fiber column was able to reduce plasma levels of IL-6, IL-10 and TNF-a, especially in patients surviving at 28 days. Use of the technique was associated with lower norepinephrine support and an increased PaO2/FiO2 ratio.

Percutaneous dilatational tracheostomy: a self-drive control technique with video fiberoptic bronchoscopy reduces perioperative complications.

BACKGROUND: The aim of this study was to demonstrate that performance of percutaneous dilatational tracheostomy (PDT) associated with a self-drive control technique lowers the incidence of complications. METHODS: A case-control, before-and-after, retrospective study. Place of study: A major teaching hospital in the Department of Emergency, Intensive Care Unit. PATIENTS: we studied 128 patients who underwent fiberoptic-guided PDT over an 18 month period of time. Thirty-nine patients were assisted by conventional fiberoptic bronchoscopy, while 89 video-assisted fiberoptic procedures were performed in which the operator controlled his own actions on a screen. We defined perioperative complications as accidental extubation, perioperative hemorrhage, tracheal ring rupture, lesions of the tracheal wall, and abnormal insertion of the cannula. A Chi-square test, Student's t-test and U Mann Whitney test were used to compare the incidence of complications and the duration of procedure in the traditional fiberoptic PDT group and in the video-guided group. RESULTS: Procedure time was significantly shorter in the group with the self-drive control technique. There was also a reduction of the number of perioperative complications. CONCLUSION: Fiberoptic bronchoscopy associated with a video system seems effective in reducing the risk of perioperative complications.