Background
Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used for patients with septic shock, and the recommended hemoperfusion period is 2 h. However, it remains unclear whether the optimal duration is 2 h or longer. The purpose of this study was to compare the effects of PMX-DHP between conventional and longer duration of PMX-DHP.
Methods
We retrospectively investigated 103 patients with sepsis who underwent PMX-DHP between April 2015 and March 2020. The demographic data, routine biochemistry, microbiological data, primary infection site were reviewed in the medical chart. The acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, heart rate, mean arterial pressure (MAP), vasoactive-inotropic score (VIS), respiratory rate, PaO2/FIO2, at baseline and day 3 were compared between the standard group (patients received 2 h of PMX-DHP) and extended group (patients received more than 2 h of PMX-DHP). Ventilator-free days, incidence of continuous renal replacement therapy, and 28-day mortality were also compared between the groups.
Results
Median MAP was significantly lower and median VIS was significantly higher in the extended group at baseline (p < 0.05, 0.01, respectively) There were no significant differences in APACHE II score, SOFA score, and PaO2/FIO2 at baseline between the two groups. The increase of MAP and the decrease in VIS from baseline to day 3 were significantly greater in the extended group (p < 0.01, respectively). In the extended group, increase in PaO2/FIO2 was significantly larger in the patients who underwent ≥ 8 h duration than that in patients who underwent < 8 h duration (p < 0.01). The ventilator-free days, the incidence of continuous renal replacement therapy, and the 28-day mortality were not different between the groups.
Conclusions
Longer duration of PMX-DHP effectively improved MAP and decreased the volume of vasoactive-inotropic agents compared with the conventional duration. Eight and longer hours duration of PMX-DHP improved the pulmonary oxygenation. Further studies are needed to confirm the efficacy of longer duration of PMX-DHP in patients with septic shock. (329/350 limits)