Clinical evaluation of PMX-DHP for hypercytokinemia caused by septic multiple organ failure.

Endotoxin-adsorbing fibers have been applied to treat septic shock patients. The limitations of endotoxin hemoadsorption therapy (PMX-DHP) and the optimal time to start PMX-DHP were examined in patients with septic multiple organ failure with hypercytokinemia (interleukin-6 = 1000 pg/mL). Subjects were separated into those who survived more than 28 days after the start of PMX-DHP therapy (S group) and those who did not (N-S group). Severity of symptoms and background factors, blood biochemical parameters, hemodynamic parameters, PaO(2)/FiO(2), pathogens, endotoxin, cytokines, and vascular endothelial cell function-related markers were examined before and after PMX-DHP. Number of days from onset of shock (or symptom development) to PMX-DHP initiation was longer in the N-S group than in the S group. These results suggest that PMX-DHP could save more lives in patients with septic multiple organ failure with IL-6 = 1000 pg/mL when applied early after the onset of shock.

Colloid osmotic pressure (COP) can be a good indicator of occurrence of vasospasm following subarachnoid hemorrhage (SAH).

BACKGROUND: The aim of this study was to evaluate the value of measurement of colloid osmotic pressure (COP) directly concerned with cerebral vasospasm following subarachnoid hemorrhage (SAH). MATERIAL/METHODS: The subjects were 20 patients who received clipping operation within 48 hours after onset. We conducted a two weeks monitoring of COP measured directly by osmometer and evaluated serum concentrations of albumin at the same time. We divided the patients into Group A (angiographical vasospasm +) and Group B (spasm -) according to the angiographical findings. The differences of the data between the groups were analyzed by ANOVA test (p<0.05). Furthermore, the correlations between the serum concentrations of albumin and COP levels were estimated. RESULTS: Vasospasm was angiographically confirmed in 10 of the 20 patients. Significant decrease of COP levels was observed from day 7 until day 11 and significant decrease of albumin was observed on day 6 and from day 8 until day 11 in the Group A. We did not observe any significant change of COP and albumin levels in the Group B. A liner analysis was performed and a significant correlation was determined between the COP levels and albumin in the Group A, but we did not observe significant correlation between them in the Group B. CONCLUSIONS: These results showed that a significant decrease of COP levels indicate the occurrence of cerebral vasospasm. We concluded that COP measurement could be a useful monitor of the occurrence of vasospasm following SAH.