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Treatment of sepsis by plasma endotoxin removal: hemoperfusion using a polymyxin-B immobilized column

First Department of Surgery, Shiga University of Medical Science, Shiga, Japan

T. Tani

First Department of Surgery, Shiga University of Medical Science, Shiga, Japan

K. Hanasawa

First Department of Surgery, Shiga University of Medical Science, Shiga, Japan

K. Hirata

First Department of Surgery, Sapporo Medical College, Sapporo, Japan

H. Hirasawa

Department of Emergency and Critical Care Medicine, Chiba University School of Medicine, Chiba, Japan

S. Oda

Department of Emergency and Critical Care Medicine, Chiba University School of Medicine, Chiba, Japan

T. Otsuka

Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama Nagayama Hospital, Tokyo, Japan

Y. Yamamoto

Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama Nagayama Hospital, Tokyo, Japan

S. Kanesaka

Showa University Fugigaoka Hospital, Yokohama, Japan

Y. Takahashi

Showa University Fugigaoka Hospital, Yokohama, Japan

K. Maekawa

Department of Traumatology and Critical Care Medicine, Faculty of Medicine, Tokyo University, Tokyo, Japan

Y. Wakabayashi

Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Sagamihara Kanagawa, Japan

S. Tamakuma

First Department of Surgery, National Defense Medical College, Japan

T. Sugimoto

Department of Traumatology, Osaka University Medical School, Osaka, Japan

The PMX Clinical Study Group

A Phase I clinical trial was carried out to evaluate the effects of endotoxin elimination by direct hemoperfusion using a cartridge containing chemically immobilized polymyxin B fibers (PMX-F). Thirty-seven endotoxemic patients with multiple organ failure (MOF) were treated. Direct hemoperfusion for 2 h using a PMX-F column was performed (PMX). PMX could remove circulating endotoxin from severely endotoxemic patients. Plasma endotoxin level was significantly decreased between its inlet and outlet level of PMX-F column (P < 0.01). The mean plasma endotoxin concentration of all PMX (n = 51) was 83.7 ± 26.7 pg/ml before PMX, and significantly decreased to 56.4 ± 27.9 after (P < 0.01). Plasma endotoxin was significantly decreased in survivors, but that of non-survivors did not change with PMX (P < 0.05). Body temperature, blood pressure, cardiac index, systemic vascular resistance and the oxygen consumption index improved significantly after PMX. Inotropic and vasopressive drugs were discontinued or reduced with PMX. PMX treatment showed a correlation between reduction of plasma endotoxin level and the improvement of septic syndrome, especially cardiovascular impairments. Also, this new therapy seemed to influence the outcome of severe sepsis or septic MOF patients with endotoxemia.

Journal of Endotoxin Research, Vol. 4, No. 4, 293-300 (1997)
DOI: 10.1177/096805199700400407


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