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Multi-center research of small-sized polymyxin B hemoperfusion

Multi-center research of small-sized polymyxin B hemoperfusion. Naohiro Wada Department of Pediatric Nephrology Shizuoka Children’s Hospital Shizuoka, JAPAN. Polymyxin B. Polymyxin B. LPS =Endotoxin Polysaccharide Lipid A. Lipid A. polymyxin B immobilized fiber column.

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Multi-center research of small-sized polymyxin B hemoperfusion

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  1. Multi-center research of small-sized polymyxin B hemoperfusion Naohiro Wada Department of Pediatric Nephrology Shizuoka Children’s Hospital Shizuoka, JAPAN

  2. Polymyxin B Polymyxin B LPS =Endotoxin Polysaccharide Lipid A Lipid A polymyxin B immobilized fiber column Polystyrene/polypropylene (9/1) conjugated fiber Covalent linkage + Anandamide 2-arachidonylglycerol (endocannabinoids) Gram –positive bacterial infection also effective

  3. Crus DN et al (Crit Care 2007;11:R47) “Effectiveness of polymixin B immobilized fiber column in sepsis: a systematic review” Review : meta-analysis Favorable effect : MAP, dopamine use, PaO2/FiO2 ratio, mortality Consideration : publication bias, lack of blinding Cruz DN et al (JAMA 2009;301:2445-2452) “Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock. The EUPHAS Randomized Controlled Trial.”

  4. PMX 20R PMX 05R Priming volume 135 ml 40 ml Length 225 mm 135 mm Diameter63 mm 55 mm

  5. PURPOSE The effectiveness and safety of small-sized polymyxin B hemoperfusion in the severe septic shock children. Retrospective analysis in three units. Complete count survey in the units. Units: pICU, Nagano Children’s Hosp. Neonatal section, Kurashiki Central Hosp. Nephrology section, Shizuoka Children’s Hosp. PATIENS Septic shock Definitions for sepsis and organ dysfunction in pediatrics (Pediatr Crit Care Med 2005;6:2-8)

  6. Cases : 36(male 24, female 12) Age : 1.6±2.6 y(0m-10y : median 0.32 y) Weight : 6.5±5.5kg(1.2kg~28kg : median 5.0kg） Data (at the time of treatment) sBP (mmHg) 77±24 HR ( /min) 144 ±33 WBC (103/mm3) 8.3±6.9 Plt (104/mm3) 8.6±8.3 BUN (mg/dl) 19.0 ±17.1 Cr (mg/dl) 0.80 ±0.67 PELOD: 35 ±11 (predictive mortality : 94.6%) Frequency : once 11 twice 25

  7. Bacterial culture detected 22 E.coli2( blood 2) Klebsiella2( blood 1、ascites 1) Pseudomonas3( blood 2、urine 1) Serratia 1( blood) MSSA5 ( blood 5) MRSA4( blood 2、 sputum 2) GBS3( blood 3） Streptococcus 2( blood 2） Endotoxin（before treatment） detected11 (1-714： mean 150.6土227.4；median 49.9) not detected9 not done16

  8. Qb 28.3 ± 15.0 ml/min(5－80) 6.2±4.0ml/min/kg(0.97～16.2：median 5.7) Anticoagrant Nafamostat mesilate : 36 (100%) 0.40±0.18 mg/kg/hr, (0.1～1.0, median 0.41) Priming Blood ＋Albumin/FFP34 albumin1　（2y:9.9kg) saline 2　（7y:26kg, 14y:18kg) Concurrent therapy（overlapped） CH(D)F36 (100%) ECMO4 ( 11%)

  9. Blood access (excluded ECMO route access) jugularv.20 femoral v.10 subclavian v.2 Catheter size　（DL) (excluded ECMO route access) 17G1 16G2 15G2 6 Fr8 6.5Fr1 7 Fr 4 8 Fr 13 10 Fr1 ※17G=4.5Fr, 16G=5Fr, 15G=5.5Fr

  10. Changes in blood pressure before and end of treatment (before therapy = 1) >1：30/52 (57%) 1.09±0.23

  11. Changes inblood pressure ( before therapy = 1)

  12. Changes in HR (before therapy = 1)

  13. Change in WBC and platelet before and 24hrs after treatment (before therapy = 1) WBC Platelet

  14. PROGNOSIS Death : 18/36 (mortality rate50%) < 7 days14(39%) 8～28 days 2 29 days< 2 PELOD 40< : 19 cases Death : 9 /19 （47％） (predicted mortality rate: 99% and more）

  15. Comparison of death group and living group

  16. Conclusion Polymyxin B hemoperfusion treatment was possible to be effective to the septic shock children safely even at low body weight and contributed to the prognosis improvement. However, other therapies effect to the mortality, randomized control trial and definite indication are necessary for the effectiveness of polymyxin B hemoperfusion itself.

  17. CHDF + PMX-DHP PMX－DHP Double lumen CHDF

  18. CH(D)F + PMX-DHP QB1 CH(D)F

  19. QB2 PMX-05R CH(D)F + PMX-DHP QB1 CH(D)F QB1>QB2

  20. CH(D)F + PMX-DHP QB1 CH(D)F

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