ABSTRACT
BACKGROUND: The factors contributing to the efficacy and outcome of direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP) after cardiac surgery were investigated. METHODS AND RESULTS: In 23 patients who received PMX-DHP for shock related to infection after cardiac surgery, there were no differences in the pre- and intraoperative clinical data of survivors (n=14) and non-survivors (n=9). Before the PMX-DHP treatment, the clinical assessment values of the survivors and non-survivors, respectively, showed the following significant differences: sepsis-related organ failure assessment score, 9.46+/-2.84 vs 12.89+/-3.37 (P<0.05); number of failed organs, 1.8+/-0.9 vs 3.1+/-1.1 (P<0.05); partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, 194+/-118 vs 102+/-29 (P<0.05); and total bilirubin, 2.7+/-2.8 vs 8.7+/-6.5 mg/dl (P<0.05). The systolic blood pressure and catecholamine index in the survivors improved significantly 12 h after PMX-DHP treatment, from 83+/-19 mmHg to 118+/-14 mmHg (P<0.01), and from 20.7+/-11.5 to 14.9+/-8.0 (P<0.05). Conversely, in the non-survivors, only the systolic blood pressure improved significantly, from 74+/-17 mmHg to 118+/-33 mmHg (P<0.001). CONCLUSIONS: Prompt initiation of PMX-DHP with drug treatment during the postoperative course of patients with septic shock caused by systemic inflammatory response syndrome related to infection and who are refractory to vasopressor treatment, can improve the disease state before multiple organ failure develops.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cardiac Surgical Procedures , Cardiovascular Diseases/surgery , Hemoperfusion , Polymyxin B/administration & dosage , Postoperative Complications/drug therapy , Shock, Septic/drug therapy , Aged , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Female , Humans , Male , Middle Aged , Multiple Organ Failure/drug therapy , Multiple Organ Failure/etiology , Multiple Organ Failure/metabolism , Multiple Organ Failure/physiopathology , Postoperative Complications/metabolism , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Retrospective Studies , Shock, Septic/metabolism , Shock, Septic/mortality , Shock, Septic/physiopathologyABSTRACT
A 76-year-old female underwent ascending aorta and partial arch replacement. She developed septic shock on postoperative day 6. She was administered dopamine, 10 microg x kg(-1) x min(-1); dobutamine, 5 microg x kg(-1) x min(-1); and norepinephrine, 0.3 microg x kg(-1) x min(-1). However, the blood pressure was 74/40 mmHg. Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was started; 3 h later, the blood pressure increased to 118/54 mmHg. Norepinephrine was stopped, and dopamine and dobutamine doses were decreased to 5 microg x kg(-1) x min(-1) 3 and 12 h after completing PMX-DHP, respectively. In suspected septic shock, early PMX-DHP simultaneously with drug treatment facilitates hemodynamic improvement.
