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KMID : 0604020150300020095
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Korean Journal of Critical Care Medicine
2015 Volume.30 No. 2 p.95 ~ p.102
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Polymyxin B Immobilized Fiber Hemoperfusion in Refractory Intra-abdominal Septic Shock
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Chang Hae-Wone
Cho Young-Jae
Park Sang-Hyun
Kim Moon-Suk
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Abstract
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The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported.However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases ofintra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatmentimproved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated withseptic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractilityassessed by echocardiography returned to baseline. In case 3, a patient with Burkitt’s lymphoma and neutropenia was foundto be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parametersimprove after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was moresignificant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged fromthe hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients withrefractory intra-abdominal infection associated with septic shock.
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KEYWORD
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hemoperfusion, intra-abdominal infection, polymyxin B, septic shock
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