Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support
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Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
Abstract
Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
참고문헌 (18)
- Martin GS, "Sepsis, severe sepsis and septic shock:changes in incidence, pathogens and outcomes", Expert Rev Anti Infect Ther, 10, pp.701~706 (2012)
- Bréchot N, "Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock", Crit Care Med, 41, pp.1616~1626 (2013)
- Park TK, "Extracorporeal membrane oxygenation for refractory septic shock in adults", Eur J Cardiothorac Surg, 47, pp.e68~e74 (2015)
- Huang CT, "Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock", J Thorac Cardiovasc Surg, 146, pp.1041~1046 (2013)
- Ronco C, "Polymyxin B hemoperfusion: a mechanistic perspective", Crit Care, 18, pp.309~ (2014)
- Cruz DN, "Effectiveness of polymyxin Bimmobilized fiber column in sepsis: a systematic review", Crit Care, 11, pp.R47~ (2007)
- Cruz DN, "Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial", JAMA, 301, pp.2445~2452 (2009)
- Weerwind PW, "Cytokine removal on extracorporeal life support for treatment of acute endotoxemia:a randomized controlled animal study", Int J Cardiol, 168, pp.4699~4704 (2013)
- Bruenger F, "First successful combination of ECMO with cytokine removal therapy in cardiogenic septic shock: a case report", Int J Artif Organs, 38, pp.113~116 (2015)
- Hirakawa E, "Septic neonate rescued by polymyxin B hemoperfusion", Pediatr Int, 55, pp.e70~e72 (2013)
- Court O, "Clinical review:Myocardial depression in sepsis and septic shock", Crit Care, 6, pp.500~508 (2002)
- Sharma AS, "Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock", J Thorac Cardiovasc Surg, 147, pp.1441~1442 (2014)
- Akira S, "Pathogen recognition by innate immunity and its signaling", Proc Jpn Acad Ser B Phys Biol Sci, 85, pp.143~156 (2009)
- Cohen J, "The immunopathogenesis of sepsis", Nature, 420, pp.885~891 (2002)
- Zhou F, "Blood purification and mortality in sepsis: a meta-analysis of randomized trials", Crit Care Med, 41, pp.2209~2220 (2013)
- Nakamura T, "Effects of hemoperfusion on serum cardiac troponin T concentrations using polymyxin B-immobilized fibers in septic patients undergoing hemodialysis", ASAIO J, 48, pp.41~44 (2002)
- Nakamura K, "Endotoxin adsorption by polymyxin B column or intraaortic balloon pumping use for severe septic cardiomyopathy", Am J Emerg Med, 31(893), pp.e1~e3 (2013)
- Sugimoto T, "A case of acute renal failure complicated with Takotsubo cardiomyopathy", Nihon Toseki Igakkai Zasshi, 37, pp.2093~2098 (2004)