Direct hemoperfusion using polymyxin-B immobilized fiber for septic shock after cardiac surgery.

BACKGROUND The factors contributing to the efficacy and outcome of direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP) after cardiac surgery were investigated. METHODS AND RESULTS In 23 patients who received PMX-DHP for shock related to infection after cardiac surgery, there were no differences in the pre- and intraoperative clinical data of survivors (n=14) and non-survivors (n=9). Before the PMX-DHP treatment, the clinical assessment values of the survivors and non-survivors, respectively, showed the following significant differences: sepsis-related organ failure assessment score, 9.46+/-2.84 vs 12.89+/-3.37 (P<0.05); number of failed organs, 1.8+/-0.9 vs 3.1+/-1.1 (P<0.05); partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, 194+/-118 vs 102+/-29 (P<0.05); and total bilirubin, 2.7+/-2.8 vs 8.7+/-6.5 mg/dl (P<0.05). The systolic blood pressure and catecholamine index in the survivors improved significantly 12 h after PMX-DHP treatment, from 83+/-19 mmHg to 118+/-14 mmHg (P<0.01), and from 20.7+/-11.5 to 14.9+/-8.0 (P<0.05). Conversely, in the non-survivors, only the systolic blood pressure improved significantly, from 74+/-17 mmHg to 118+/-33 mmHg (P<0.001). CONCLUSIONS Prompt initiation of PMX-DHP with drug treatment during the postoperative course of patients with septic shock caused by systemic inflammatory response syndrome related to infection and who are refractory to vasopressor treatment, can improve the disease state before multiple organ failure develops.