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Direct hemoperfusion with polymyxin B-immobilized fiber improves shock and hypoxemia during endotoxemia in anesthetized sheep

First Departments of Medicine and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan

Tomonobu Koizumi

First Departments of Medicine and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan, tomonobu{at}hsp.md.shinshu-u.ac.jp

Toshimichi Kaneki

First Departments of Medicine and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan

Keisaku Fujimoto

First Departments of Medicine and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan

Keishi Kubo

First Departments of Medicine and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan

Takayuki Honda

First Departments of Medicine and Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan

This study evaluates the effect of direct hemoperfusion (DHP) using polymyxin B-immobilized fibers (PMX-F) as an extracorporeal blood filter on systemic hypotension and lung injury during endotoxemia. Sheep were anesthetized, intubated, mechanically ventilated with 50% oxygen and connected to the DHP system between the right femoral artery and left jugular vein. Group 1 (n = 6) sheep were infused with 10 µg/kg Escherichia coli endotoxin over a 30 min period. At the same time, sheep underwent DHP with PMX-F (Toraymyxin^®: PMX-20R) for 2 h at a flow rate of 60 ml/h. Group 2 (n = 6) sheep were infused with the same dose of endotoxin and treated with a sham column, in the same manner as those in group 1. DHP with PMX-F significantly improved and restored systemic pressure and arterial oxygen tension in group 1 sheep, although these values never returned to the baseline levels of group 2 sheep. Pulmonary hypertension and leukocytopenia were observed after endotoxin infusion in both groups, but there were no significant differences between these values. DHP with PMX-F significantly decreased the elevation of plasma nitric oxide products. The treatment with PMX-F improves shock and deteriorated oxygenation during endotoxemia, probably through the suppression of nitric oxide production.

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