Effectiveness of polymyxin B-direct hemoperfusion (PMX-DHP) therapy using a polymyxin B-immobilized fiber column in patients with post-esophagectomy sepsis
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Post-esophagectomy complications have an extremely poor prognosis. Recently, polymyxin B-direct hemoperfusion (PMX-DHP) therapy using a polymyxin B-immobilized fiber column was reported to be beneficial in gram-negative and/or gram-positive bacterial sepsis. The present retrospective study investigated the effectiveness and safety of PMX-DHP therapy in severe sepsis or septic shock after esophagectomy.
Fifteen severe sepsis or septic shock patients were included. Seven (four, pneumonia; two, anastomotic leakage; and one, reconstructed colon necrosis) patients received 2–5 h of PMX-DHP therapy (PMX-DHP therapy group), whereas 8 (three, pneumonia; three, anastomotic leakage; and two, gastric tube necrosis) received conventional therapy (control group).
Length of stay in the intensive care unit (ICU) was significantly shorter in the PMX-DHP therapy group than in the conventional therapy group (P = 0.040). In the comparison of pre- and post-PMX-DHP therapy groups, the total Sequential Organ Failure Assessment (SOFA) score, respiratory system score, and P/F ratio improved (P = 0.0027, P = 0.025, and P = 0.0087, respectively) in the post-PMX-DHP therapy group. In the comparison of conventional and PMX-DHP therapy groups, the variations in the total SOFA score, respiratory system score, and P/F ratio improved (P = 0.019, P = 0.0063, and P = 0.0015, respectively) in the PMX-DHP therapy group. Moreover, the respiratory system score was lower (P = 0.0062) in the PMX-DHP therapy group at the time of discharge from the ICU. No adverse effects were observed during the course of PMX-DHP therapy.
PMX-DHP therapy was safe and effective in improving respiratory and general conditions of patients with severe sepsis and septic shock after esophagectomy and decreased the length of stay in the ICU.
KeywordsEsophagectomy Postoperative complications Sepsis Hemoperfusion
This study was approved by the Ethics Committee of Keio University School of Medicine and was in accordance with the Helsinki Declaration of 1975, as revised in 2000 and 2008.
Conflict of interest
There are no financial or other relations that could lead to a conflict of interest.
- 14.Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T, Katsuda M, Tsuji T, Nakatani Y, Yamaue H. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2008;393:127–33.PubMedCrossRefGoogle Scholar
- 17.Dhungel B, Diggs BS, Hunter JG, Sheppard BC, Vetto JT, Dolan JP. Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005–2008. J Gastrointest Surg. 2010;14:1492–501.PubMedCrossRefGoogle Scholar
- 18.Valenti V, Hernandez-Lizoain JL, Marinez-Regueira F, Bellver M, Rodriguez J, Diaz Gonzalez JA, Valenti V, Torres W, Sola JJ, Alvarez-Cienfuegos J. Transthoracic oesophagectomy with lymphadenectomy in 100 oesophageal cancer patients: multidisciplinary approach. Clin Transl Oncol. 2011;13:899–903.PubMedCrossRefGoogle Scholar
- 28.Tani T, Hanasawa K, Kodama M, Imaizumi H, Yonekawa M, Saito M, Ikeda T, Yagi Y, Takayama K, Amano I, Shimaoka H, Ohta M, Okahisa T, Koga N, Fujita N, Yamasa H. Correlation between plasma endotoxin, plasma cytokines, and plasminogen activator inhibitor-1 activities in septic patients. World J Surg. 2001;25:660–8.PubMedCrossRefGoogle Scholar
- 33.Nakamura T, Kawagoe Y, Matsuda T, Shoji H, Ueda Y, Tamura N, Ebihara I, Koide H. Effect of polymyxin B-immobilized fiber on blood metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels in acute respiratory distress syndrome patients. Blood Purif. 2004;22:256–60.PubMedCrossRefGoogle Scholar
- 34.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest. 1992;101:1644–55.PubMedCrossRefGoogle Scholar
- 37.Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S. The use of maximum sofa score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working group on sepsis related problems of the ESICM. Intensive Care Med. 1999;25:686–96.PubMedCrossRefGoogle Scholar
- 39.Kojika M, Sato N, Yaegashi Y, Suzuki Y, Suzuki K, Nakae H, Endo S. Endotoxin adsorption therapy for septic shock using polymyxin B-immobilized fibers (PMX): evaluation by high-sensitivity endotoxin assay and measurement of the cytokine production capacity. Ther Apher Dial. 2006;10:12–8.PubMedCrossRefGoogle Scholar
- 41.Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.PubMedCrossRefGoogle Scholar
- 42.Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, Malcangi V, Petrini F, Volta G, Bobbio Pallavicini FM, Rottoli F, Giunta F, Ronco C. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA. 2009;301:2445–52.PubMedCrossRefGoogle Scholar
- 43.Jaber BL, Barrett TW, Neto MC, Sundaram S, King AJ, Pereira BJ. Removal of cytokine inducing substances by polymyxin-B immobilized polystyrene-derivative fibers during in vitro hemoperfusion of 10% human plasma containing staphylococcus aureus challenge. ASAIO J. 1998;44:48–53.PubMedCrossRefGoogle Scholar
- 46.Nakamura T, Ebihara I, Shoji H, Ushiyama C, Suzuki S, Koide H. Treatment with polymyxin B-immobilized fiber reduces platelet activation in septic shock patients: decrease in plasma levels of soluble p-selectin, platelet factor 4 and beta-thromboglobulin. Inflamm Res. 1999;48:171–5.PubMedCrossRefGoogle Scholar
- 48.Sakamoto Y, Mashiko K, Matsumoto H, Hara Y, Kutsukata N, Takei K, Ueno Y, Tomita Y, Yamamoto Y. Effect of direct hemoperfusion with a polymyxin B immobilized fiber column on high mobility group box-1 (HMGB-1) in severe septic shock: report of a case. ASAIO J. 2006;52:e37–9.PubMedCrossRefGoogle Scholar
- 49.Suda K, Kitagawa Y, Ozawa S, Saikawa Y, Ueda M, Abraham E, Kitajima M, Ishizaka A. Serum concentrations of high-mobility group box chromosomal protein 1 before and after exposure to the surgical stress of thoracic esophagectomy: a predictor of clinical course after surgery? Dis Esophagus. 2006;19:5–9.PubMedCrossRefGoogle Scholar