Is it true that PMX-DHP can improve lung oxygenation?

T Ikeda,K Ohshima,Y Kuroki,K Ikeda,H Suzuki,M Nagura,H Taniuchi,N Matsuno

doi:10.1186/cc2106

Abstract

Polymyxin B immobilized fiber (PMX-R; Toray industries, Inc) has been developed in Japan for direct removal of endotoxin (PMX-DHP). PMX-DHP is used for treatment of patients with sepsis and septic shock primarily caused by Gram-negative infections, and its effectiveness of hemodynamic changes has been evaluated. In 119 cases (62 ± 16 years old, 82 men and 37 women) treated with PMX-DHP, changes in pulmonary oxygenation before and after PMX-DHP were examined, using PaO2/FiO2 as an oxygenation indicator, separately according to the outcome (80 survivors and 39 who died). Improvement of PaO2/FiO2 was identified in 64% of all cases. In the survival group, there appeared to be a trend for PaO2/FiO2 improvement as blood pressure increased. In the non-survival group, however, no improvement of PaO2/FiO2 was obtained, regardless of an increase of blood pressure. There was no significant correlation between PaO2/FiO2 and the rate of change in endotoxin levels, TNF-α, and IL-6. Granulocyte elastase increased significantly after PMX-DHP treatment in both groups. In the survival group, PaO2/FiO2 appeared to increase as macrophage inflammatory protein (MIP-1) 1-α decreased, suggesting the possibility that changes in MIP-1-α influenced PaO2/FiO2. As the mechanism for the improvement of pulmonary oxygenation by PMX-DHP has been shown clearly, it remains to be examined further.

Highlights

Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis
Arterial blood gases (ABGs) are the immediate, easiest, most reliable and cost effective bedside method of assessing an unstable patient. It portrays an array of functional reserves from the lungs to the kidneys and the blood cells in between
A significant benefit was demonstrated with amikacin/ceftazidime versus pefloxacin/ceftazidime, risk difference (RD) = 20%, in a single low-quality trial

Summary

Introduction

Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis. The aim of the study was to evaluate the effects of PEEP on intrathoracic blood volumes and cardiac function measured by the COLD system in ARDS patients. The objective was to identify risk factors and outcome of pregnant women who required intensive care This pilot study aims to find stress (S) and other personality traits (physical symptoms [PS], anger [A]) among the ICU staff, and any existing correlation between them and length of working time (LWT) in the ICU and with educational level (EDL). The role of Drotrecogin alfa (activated) (recombinant human activated protein C [rhAPC]) in modulating microvascular coagulation through the inhibition of thrombin generation has been well studied in experimental and clinical settings of severe sepsis, little is known about its direct anti-inflammatory effects on vascular endothelial cells. The aim is to determine whether an effective lifestyle adaptation program post CABG could enhance the quality of life of the CABG patient

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