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Early Hemoperfusion With a Polymyxin B Column Improves Gastric Intramucosal pH in Sepsis
Author(s) -
Kushi Hidehiko,
Miki Takahiro,
Sakagami Yuichiro,
Sato Jun,
Saito Takeshi,
Tanjoh Katsuhisa
Publication year - 2008
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2008.00588.x
Subject(s) - medicine , hemoperfusion , polymyxin b , polymyxin , sepsis , gastroenterology , anesthesia , microbiology and biotechnology , antibiotics , hemodialysis , biology
This study had two purposes. One was to assess gastric intramucosal pH (pHi) after early goal‐directed therapy in patients with sepsis and septic shock. The other was to determine whether direct hemoperfusion with a polymyxin B fiber column (DHP‐PMX) could improve the pHi if it remained low after early goal‐directed therapy. The subjects were 32 patients who underwent early goal‐directed therapy within 6 h of a diagnosis of sepsis or septic shock, and who achieved the following conditions: (i) central venous pressure of 8–12 mm Hg; (ii) mean arterial blood pressure ≥65 mm Hg; (iii) urine output ≥0.5 mL/kg/h; and (iv) mixed venous oxygen saturation ≥70%. A gastric tonometer was inserted in each patient and the pHi was measured before DHP‐PMX, and at 24, 48, and 72 h after the start of treatment. The pHi was 7.22 ± 0.04 immediately before DHP‐PMX, 7.28 ± 0.03 ( P < 0.05) at 24 h, 7.32 ± 0.03 ( P < 0.01) at 48 h, and 7.34 ± 0.02 ( P < 0.01) at 72 h, showing a significant increase from 24 h onward compared with the pretreatment value. In patients with sepsis and septic shock, the pHi remained low after early goal‐directed therapy; however, it was significantly improved from 24 h after the start of DHP‐PMX and was normalized from 48 h onwards. These findings suggest that DHP‐PMX improves pHi. Because this was a prospective uncontrolled observational study on a limited number of patients, larger multicenter clinical trials are required to more accurately assess the benefits of DHP‐PMX.