Premium
Direct hemoperfusion with polymyxin B ‐immobilized fibre treatment for acute exacerbation of interstitial pneumonia
Author(s) -
Furusawa Haruhiko,
Sugiura Makiko,
Mitaka Chieko,
Inase Naohiko
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13054
Subject(s) - hemoperfusion , medicine , exacerbation , idiopathic interstitial pneumonia , polymyxin b , gastroenterology , idiopathic pulmonary fibrosis , intensive care unit , interstitial lung disease , lung , antibiotics , hemodialysis , microbiology and biotechnology , biology
Background and objective Acute exacerbation of idiopathic pulmonary fibrosis ( AE‐IPF ) is recognized as an important cause of mortality. AE has also been reported in patients with other interstitial lung diseases such as idiopathic non‐specific interstitial pneumonia ( NSIP ) and interstitial pneumonia associated with collagen vascular disease ( CVD ). Current therapies such as high‐dose corticosteroid with immunosuppressive agents have provided little benefit for AE . Direct hemoperfusion ( DHP ) with a polymyxin B‐immobilized fibre column ( PMX ) was originally developed for the treatment of endotoxaemia. Recent clinical reports have suggested beneficial effects of PMX‐DHP treatment on patients with AE . In this study, we evaluated the effectiveness and safety of PMX‐DHP treatment for patients with AE . Methods The clinical records of patients with AE admitted to our intensive care unit between 2006 and 2015 were retrospectively reviewed. Results Of 54 patients with AE identified from clinical records, 24 were treated with PMX‐DHP and 30 were treated without PMX‐DHP . The peripheral white blood cell count was significantly decreased ( P < 0.001) and the PaO 2 / FiO 2 (P/F) ratio was significantly improved after PMX‐DHP ( P = 0.032). While no significant difference was found in the survival proportion between patients treated with and without PMX‐DHP , the prognosis of patients with dermatomyositis was significantly improved with the treatment ( P = 0.045). Among the PMX‐DHP ‐treated patients, those who received the treatment within 3 days of AE onset tended to have a better prognosis ( P = 0.026). Conclusion The early induction of PMX‐DHP treatment may improve the prognosis of patients with AE , especially those with dermatomyositis.