Hemoperfusion In Patients Research Articles

Descripción de los efectos hemodinámicos y respiratorios del tratamiento mediante hemoperfusión con polimixina B en pacientes con shock séptico de origen abdominal

The objective of this study is to describe the hemodynamic effects, inotropic and vasoactive drug dependence, and to analyze the PO2/FiO2 ratio in 13 patients with septic shock of abdominal origin after hemoperfusion treatment with polymyxin-B. Treatment with polymyxin hemoperfusion therapy is indicated for patients with severe sepsis/septic shock of abdominal origin who do not respond adequately to conventional therapy.Two complete cycles with polymyxin cartridge were performed on 11 of the 13 patients, and a single cycle on the other O2. After treatment, the mean airway pressure (MAP) was increased (P=.003), the need for norepinephrine decreased (P=.003), and the PO2/FiO2 ratio increased (P=.02).The use of polymyxin hemoperfusion in patients with septic shock of intra-abdominal origin can significantly improve hemodynamic and respiratory functions.

Analysis of clinic efficacy on early repeated hemoperfusion in patients with acute paraquat poisoning

Objective To explore the clinic efficacy on early repeated hemoperfusion in patients with acute paraquat (PQ) poisoning by analyzing the clinical data of 168 patients.Methods A total of 168 patients with acute paraquat poisoning,admitted to our emergency intensive care unit (EICU) from January 2008 to February 2011 were retrospectively analyzed.The PQ poisoning patients were divided into HP group (n =81,group A) and non-HP group (n =87,group B).The early repeated HP was carried out for at least 2 times within 24 hours after poisoning.The chi-square test and t test were used to detect the difference in outcome between groups.Results There were 52 patients (64.2％) in group A died and 68 fatalities (78.2％) in group B (x2 =4.01,P =0.042).The first HP was carried out in patients of group A within (3.6 ± 3.3) h after poisoning,and the patients in the group A received HP for (2.9 ± 1.4) times.On the second day after poisoning,sequential organ failure assessment (SOFA) scores of 168 patients were higher than those at admission (P ＜ 0.05).SOFA scores of patients in the group A were higher than that in the group B on the third day and on the forth day (P ＜ 0.05).In the group B,alanine aminotransferase (ALT)＞ 80 U/L and total bilirubin (TBIL) ＞ 34.2 μmol/L occurred earlier than those in group A (P ＜ 0.05)and there were more patients with abnormal creatinine and arterial oxygen and those abnormalities occurred earlier than those in group A (P ＜0.05).The maximum value of ALT,TBIL,creatinine,amylase (AMS)and CK-MB in the group B were higher than those in group A (P ＜ 0.05),the lowest value of PaO2 (＜ 60mm Hg) in group B were lower than that in group A (P ＜ 0.05).Conclusions The early repeated HP can delay organ injury after acute paraquat poisoning and reduce the extent of injure,giving ample time to get advanced treatment measures to improve the prognosis of patients. Key words: Hemoperfusion; Paraquat; Poisoning

Get the Toxin Out

In Japan, treatment of severe sepsis frequently includes hemoperfusion using immobilized polymyxin B, an endotoxin binder. However, data supporting this therapy are limited. Now, investigators in Italy have conducted a multicenter, controlled trial of polymyxin B hemoperfusion in patients with severe sepsis stemming from an intra-abdominal infection that had required emergency surgery. …

Improving of APACHE II score at the early phase using CTR-001 direct hemoperfusion in patients with severe sepsis and septic shock

We reported the clinical efficacy of a newly developed cytokine adsorption column (CTR-001; Kaneka Co., Osaka, Japan) for the septic patients at the previous meeting. Especially, increasing blood pressure was remarkable during use of CTR-001 in septic shock patients. In this study, we investigate that clinical efficacy concerning the improvement of APACHE II and SOFA scores.

Blood Purification for Critical Illness: Cytokines Adsorption Therapy

Blood purification therapies have been clinically applied to treat cytokine-induced pathological effects. The effects of broad-spectrum adsorption using Lixelle (beta2-microglobulin adsorption column; Kaneka Corporation, Osaka, Japan) for the condition of hypercytokinemia in vitro, in an animal model and in humans with sepsis were investigated. We found that Lixelle could selectively adsorb not only beta2-microglobulin but also cytokines composed of glycoproteins in vitro. In addition, Lixelle beads could adsorb not only endotoxin (ET) but also microbial fragments such as peptidoglycan (PG) which is a component of Gram-positive bacteria. Hypercytokinemic rats were connected to a direct hemoperfusion (DHP) system using a mini Lixelle column and time-course changes in plasma levels of inflammatory cytokines were examined. In addition, a Lixelle column was used in direct hemoperfusion in patients with systemic inflammatory response syndrome (SIRS), and the relationship between a decrease in cytokines and clinical course was examined. The increases in plasma levels of IL-6 and tumor necrosis factor-alpha (TNF-alpha) were significantly inhibited in the group treated with the Lixelle column in an animal model. In humans with sepsis, for IL-1beta, IL-1Ra, IL-6, IL-8, and TNF-alpha, the adsorbing rates in vivo before and after the use of the Lixelle column tended to decrease with time. However, the reduction rates at 5 min after the start were 31.4, 39.3, 36.4, 76.2 and 71.6%, respectively, and at 3 h after the start, the rates were 18.0, 17.7, 12.9, 31.8, and 32.9%, respectively. Clinically, their blood pressure increased and they recovered from shock status. These results suggest that SIRS and sepsis with hypercytokinemia can be treated with the DHP using the Lixelle column.

Direct hemoperfusion by using Lixelle® column for the treatment of systemic inflammatory response syndrome

We have previously reported that Lixelle which was used for beta2-microglobulin (BMG) adsorption column could adsorb not only BMG but also inflammatory cytokines and microbial fragments such as endotoxin (ET) and peptidoglycan (PG). The aim of this study was to estimate that an adsorbent column was used in direct hemoperfusion in patients clinically having systemic inflammatory response syndrome (SIRS), and the relationship between a decrease in cytokines and clinical course was examined. Meanwhile, as regards in vivo rate of removing cytokine based on pre-treatment cytokine concentration versus pre-column concentration at the time of evaluation, it increased with lapse of time, and the removing rate was 40% with 4 h direct hemoperfusion by using the Lixelle column in some of the patients. As to in vivo rates of adsorbing IL-1beta, IL-1Ra, IL-6, IL-8 and TNF-alpha before and after the use of column at the time of evaluation, the rates 5 min after the start were 31.4, 39.3, 36.4, 76.2 and 71.6% respectively. Clinically, it was possible to increase blood pressure and recover from shock status. With the use of this column, removal of inflammatory cytokine by adsorption can be expected. Thus, it can be applied to the treatment of hypercytokinemia.

Artificial cells with emphasis on bioencapsulation in biotechnology

The most common use of artificial cells is for bioencapsulation of biologically active materials. Each artificial cell can contain combinations of materials. The permeability, composition and shape of an artificial cell membrane can be varied using different types of synthetic or biological materials. These possible variations in contents and membranes allow for large variations in the properties and functions of artificial cells. Artificial cells containing adsorbents have been a routine form of treatment in hemoperfusion for patients. This includes acute poisoning, high blood aluminum and iron, and supplement to dialysis in kidney failure. Artificial red blood cell substitutes based on modified hemoglobin are already in Phase I and Phase II clinical trials in patients. Artificial cell encapsulated cell cultures are being studied for the treatment of diabetes, liver failure, gene therapy and other conditions. Research on artificial cells containing enzymes includes their use for treatment in hereditary enzyme deficiency diseases and other diseases. Recent demonstration of extensive enterorecirculation of amino acids in the intestine has allowed oral administration to deplete specific amino acids. One example is phenylketonuria, an inborn error or metabolism resulting in high systemic phenylalanine levels. Preliminary clinical studies in patients using bioencapsulation of cells or enzymes have started. Artificial cells containing complex enzyme systems convert wastes like urea and ammonia into essential amino acids. Artificial cells are being used for the production of monoclonal antibodies, interferon and other biotechnological products. Other areas of biotechnological uses include drug delivery, and other areas of biotechnology, chemical engineering and medicine.

Artificial cells in immobilization biotechnology.

Artificial cells contain biologically active materials. Artificial cells containing adsorbents have been a routine form of treatment in hemoperfusion for patients. This includes acute poisoning, high blood aluminum and iron, and supplement to dialysis in kidney failure. Artificial cells are being tested for use as red blood cell substitutes. Artificial cells encapsulated cell culture are being tested in animals for the treatment of diabetes and liver failure. A novel 2 step method has prevented xenograft rejection. Artificial cells containing enzymes are being studied for treatment in hereditary enzyme deficiency diseases and other diseases. Recent demonstration of extensive enterorecirculation of amino acids in the intestine has allowed its oral administration to deplete specific amino acids. Artificial cells containing complex enzyme system convert wastes like urea and ammonia into essential amino acids. Artificial cell is being used for the production of monoclonal antibodies, interferons and other biotechnological products. It is also being investigated for drug delivery, and for use in other applications in biotechnology, chemical engineering and medicine.

Argument Against Hemoperfusion in Drug Overdose

<h3>To the Editor.—</h3> The editorial by Michael C. Gelfand, MD (240:2762, 1979), in a recent issue ofThe Journalpromotes the use of charcoal hemoperfusion in patients with drug overdose and stage IV coma. This more aggressive therapeutic approach was rationalized by a mortality of 34% in such patients, as reported by Arieff and Friedman¹in 1973. In our experience, patients with severe drug overdose in stage IV coma have had a much lower mortality than that reported by these latter-mentioned authors. This has been accomplished with conservative care, an approach that others^2,3have shown results in excellent survival. At the Montreal General Hospital, we have had an ongoing prospective study of adult suicidal drug overdose, conducted by the Division of Clinical Pharmacology, which supervises patient care from admission to discharge. Data for the four-year period from 1975 to 1979 show that 942 patients came to the emergency room