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Esophagus

, Volume 11, Issue 3, pp 189–196 | Cite as

Effectiveness of polymyxin B-direct hemoperfusion (PMX-DHP) therapy using a polymyxin B-immobilized fiber column in patients with post-esophagectomy sepsis

  • Masashi Takahashi
  • Hiroya Takeuchi
  • Hirofumi Kawakubo
  • Rieko Nakamura
  • Tsunehiro Takahashi
  • Norihito Wada
  • Yoshiro Saikawa
  • Tai Omori
  • Yuko Kitagawa
Original Article

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Esophagectomy Postoperative complications Sepsis Hemoperfusion 

Notes

Ethical Statement

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.

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Copyright information

© The Japan Esophageal Society and Springer Japan 2014

Authors and Affiliations

  • Masashi Takahashi
    • 1
  • Hiroya Takeuchi
    • 1
  • Hirofumi Kawakubo
    • 1
  • Rieko Nakamura
    • 1
  • Tsunehiro Takahashi
    • 1
  • Norihito Wada
    • 1
  • Yoshiro Saikawa
    • 1
  • Tai Omori
    • 1
  • Yuko Kitagawa
    • 1
  1. 1.Department of SurgeryKeio University School of MedicineShinjuku-kuJapan

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