RESUMO
BACKGROUND: We investigated whether early initiation of hemoperfusion with a polymyxin B cartridge (PMX) after the diagnosis of septic shock could improve the clinical outcome. METHODS: A prospective, open-labeled, multicenter cohort study was performed at intensive care units in Japan. 41 patients received PMX within 6 h after the diagnosis of septic shock (early group) and 51 patients were treated after 6 h (late group). RESULTS: The early group had a significantly shorter duration of ventilator support and also had a lower catecholamine requirement. PMX was effective for improvement of hypotension, hypoperfusion, the sequential organ failure assessment score, and pulmonary oxygenation regardless of the timing of its initiation. The 28-day mortality rate did not differ between the two groups. CONCLUSIONS: Early initiation of PMX shortened the duration of ventilator support and also reduced the catecholamine requirement, so early treatment of septic shock should achieve a better outcome.
Assuntos
Antibacterianos/uso terapêutico , Hemoperfusão/métodos , Polimixina B/uso terapêutico , Choque Séptico/terapia , Idoso , Catecolaminas/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Hipotensão/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Ventiladores MecânicosRESUMO
A 70-year-old male was admitted to hospital for a liver tumor. We diagnosed that hepatocellular carcinoma (HCC), 1.5 cm in diameter, by several examinations. We performed ultrasonically guided radio-frequency ablation (RFA). Ultrasonography (US) 9 days post-therapy revealed a cystic lesion 1.5 cm in diameter. Color Doppler US revealed color imaging throughout the lesion and dynamic computed tomography (CT) demonstrated an area of hyperattenuation. Intrahepatic pseudoaneurysm was diagnosed. On 14 days post-therapy, no color signals on color Doppler US or enhanced areas on CT were seen. We submit that pseudoaneurysm should be recognized as a complication of radio-frequency ablation.
