Original Investigations: Pathogenesis and TreatmentEndotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock☆,☆☆
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Patients and methods
DHP using an adsorbent column with PMX-F (PMX-F column; Toray Industries Inc, Tokyo, Japan) is recommended for patients with septic shock caused by gram-negative bacilli. However, because blood culture results and blood endotoxin concentrations were not obtained immediately after the onset of shock, the diagnosis of endotoxic shock was based on clinical features (Table 1). Patients with cardiogenic or hemorrhagic shock were excluded from the study. All patients had already been treated with
Results
Table 2 lists causative microorganisms of sepsis in our patients.
Microorganism No. of Cases Gram-negative bacillus 15 Escherichia coli 8 Pseudomonas aeruginosa 6 Klebsiella pneumoniae 1 Gram-positive bacteria 2 Methicillin-resistant Staphylococcus aureus 1 Enterococcus species 1 Unknown/others 8
Discussion
The administration of endotoxin or pyrogenic LPS extract to healthy humans results in shock with hyperdynamic circulation.9, 10 Furthermore, antiendotoxin therapy using a lipid A analogue blocks the hyperdynamic circulatory disturbance in humans with experimental endotoxemia.27 Cardiodepressant effects of endotoxin have been documented in a number of experimental settings, both in vivo and in cardiomyocytes of endotoxin-treated animals ex vivo in vitro.1, 6, 28, 29, 30, 31 Ventricular
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Polymyxin B immobilized nanofiber sponge for endotoxin adsorption
2019, European Polymer JournalCitation Excerpt :What’s more, the amount of PMB immobilized on the carriers was always low, so that the adsorption capacity was not so good [19–22]. Therefore, it is important to develop an endotoxin absorbent with both low cost and outstanding adsorption performance to meet the demand of clinical application [23]. Electrospinning is a special technology to manufacture nanofibers, which has attracted more and more attention recently [24–27].
Co-administration of phospholipid emulsion with first dose bacteriocidal antibiotic may retard progression of the sepsis response in gram negative septicaemia
2014, Medical HypothesesCitation Excerpt :To date the greatest success with LPS mitigation comes from studies examining the use of hemoperfusion with polymyxin B impregnated columns, designed to bind circulation endotoxin thereby effectively eliminating it from the bloodstream [17]. Numerous studies of have demonstrated clinical benefits of this therapy, with improvements in hemodynamic performance, reduced end organ dysfunction, and greater survival reported with clinical application [18–20]. Such data clearly support the concept of LPS elimination as beneficial in treatment of sepsis.
Usefulness of haemoperfusion in the treatment of the severe septic patient: An update
2013, Revista Espanola de Anestesiologia y ReanimacionEndotoxin removal devices for the treatment of sepsis and septic shock
2011, The Lancet Infectious DiseasesCitation Excerpt :In Japan, the device has been widely used for the treatment of sepsis since 1994, when Toraymyxin was accepted by the national health insurance scheme. Several open-label trials have assessed endotoxin concentrations and other physiological markers such as mean arterial pressure, cardiac index, and oxygen consumption index.38,39 However, despite widespread use in Japan, polymyxin devices have not been adopted elsewhere.
Endotoxin-induced activation of equine digital vein endothelial cells: Role of p38 MAPK
2009, Veterinary Immunology and Immunopathology
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Address reprint requests to Kazo Kaizu, MD, Kidney Center, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu, 807-8555, Japan. E-mail: [email protected]
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