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Li Bassi G, Marti JD, Xiol EA, Comaru T, De Rosa F, Rigol M, Terraneo S, Rinaudo M, Fernandez L, Ferrer M, Torres A. The effects of direct hemoperfusion using a polymyxin B-immobilized column in a pig model of severe Pseudomonas aeruginosa pneumonia. Ann Intensive Care 2016; 6:58. [PMID: 27378201 PMCID: PMC4932027 DOI: 10.1186/s13613-016-0155-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
Background Hemoperfusion through a column containing polymyxin B-immobilized fiber (PMX-HP) is beneficial in abdominal sepsis. We assessed the effects of PMX-HP in a model of severe Pseudomonas aeruginosa pneumonia. Methods Eighteen pigs with severe P. aeruginosa pneumonia were mechanically ventilated for 76 h. Pigs were randomized to receive standard treatment with fluids and vasoactive drugs, or standard treatment with two 3-h PMX-HP sessions. Antibiotics against P. aeruginosa were never administered. We assessed endotoxemia through the endotoxin activity assay (EA). We measured the static lung elastance, ratio of arterial partial pressure per inspiratory fraction of oxygen (PaO2/FIO2), mean arterial pressure, cardiac output, systemic vascular resistance and inotropic score. Finally, every 24 h, we assessed complete blood count. Results In comparison with the control group, PMX-HP decreased percentage of circulating neutrophils from 47.4 ± 13.8 to 40.8 ± 11.5 % (p = 0.009). In a subgroup of animals with the worst hemodynamic impairment, EA in the control and PMX-HP groups was 0.50 ± 0.29 and 0.29 ± 0.14, respectively (p = 0.018). Additionally, in the control and PMX-HP groups, static lung elastance was 26.9 ± 8.7 and 25.3 ± 7.5 cm H2O/L (p = 0.558), PaO2/FIO2 was 347.3 ± 61.9 and 356.4 ± 84.0 mmHg (p = 0.118), mean arterial pressure was 81.2 ± 10.3 and 81.6 ± 13.1 mmHg (p = 0.960), cardiac output was 3.30 ± 1.11 and 3.28 ± 1.19 L/min (p = 0.535), systemic vascular resistance was 1982.6 ± 608.4 and 2011.8 ± 750.0 dyne/s/cm–5 (p = 0.939), and inotropic score was 0.25 ± 0.10 and 0.26 ± 0.18 (p = 0.864). Conclusions In mechanically ventilated pigs with severe P. aeruginosa pneumonia, PMX-HP does not have any valuable clinical benefit, and studies are warranted to fully evaluate a potential role of PMX-HP in septic shock associated with severe pulmonary infections. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0155-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gianluigi Li Bassi
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain.,University of Barcelona, Barcelona, Spain
| | - Joan Daniel Marti
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain
| | - Eli Aguilera Xiol
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain
| | - Talitha Comaru
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain
| | - Francesca De Rosa
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,University of Milan, Milan, Italy
| | - Montserrat Rigol
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain
| | - Silvia Terraneo
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,University of Milan, Milan, Italy
| | - Mariano Rinaudo
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain
| | - Laia Fernandez
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain.,University of Barcelona, Barcelona, Spain.,Research Laboratory, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain
| | - Miguel Ferrer
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain.,University of Barcelona, Barcelona, Spain
| | - Antoni Torres
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clínic, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Majorca, Spain. .,University of Barcelona, Barcelona, Spain.
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DeClue AE, Osterbur K, Bigio A, Sharp CR. Evaluation of serum NT-pCNP as a diagnostic and prognostic biomarker for sepsis in dogs. J Vet Intern Med 2011; 25:453-9. [PMID: 21457321 DOI: 10.1111/j.1939-1676.2011.0713.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a need for diagnostic biomarkers that can rapidly differentiate dogs with sepsis from dogs with noninfectious forms of systemic inflammatory response syndrome (NSIRS). OBJECTIVES To compare serum NT-pCNP concentrations among dogs with various forms of sepsis, NSIRS, and healthy controls and to evaluate the use of serum NT-pCNP for the diagnosis of various forms of sepsis in dogs. ANIMALS One hundred and twelve dogs including 63 critically ill dogs (sepsis n = 29; NSIRS n = 34) and 49 healthy control dogs. METHODS Prospective clinical investigation. Serum samples were collected for NT-pCNP measurement from dogs with sepsis or NSIRS within 24 hours of intensive care unit admission or at the time of presentation for healthy dogs. Dogs with sepsis were subclassified based on the anatomic region of infection. Serum NT-pCNP concentrations were compared among sepsis, NSIRS and healthy groups as well as among sepsis subgroups. The area under the curve (AUC), sensitivity, and specificity for identifying dogs with sepsis were determined. RESULTS Using a cut-off value of 10.1 pmol/L, AUC, sensitivity, and specificity of NT-pCNP for differentiating dogs with sepsis from dogs with NSIRS or healthy control dogs were 0.71 (95% CI, 0.58-0.85), 65.5% (45.7-82.1%), and 89.2% (80.4-94.9%), respectively. Serum NT-pCNP had poor sensitivity for peritoneal sources of sepsis; AUC [0.92 (0.81-1.0)], sensitivity [94% (71-100%)], and specificity [89% (80-95%)] improved when these dogs were excluded. Serum NT-pCNP concentration was not associated with survival in the sepsis group. CONCLUSIONS AND CLINICAL IMPORTANCE Serum NT-pCNP is a promising diagnostic biomarker for sepsis but is a poor indicator of septic peritonitis.
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Affiliation(s)
- A E DeClue
- Comparative Internal Medicine Laboratory, Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA.
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Koenig JB, Hart J, Harris DM, Cruz AM, Bienzle D. Evaluation of endotoxin activity in blood measured via neutrophil chemiluminescence in healthy horses and horses with colic. Am J Vet Res 2009; 70:1183-6. [PMID: 19795931 DOI: 10.2460/ajvr.70.10.1183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the performance of a chemiluminescent endotoxin activity assay in horses with colic and healthy horses. ANIMALS 20 horses with colic and systemic inflammatory response syndrome (SIRS group), 8 horses with colic with no SIRS (NSIRS group), and 20 healthy horses. PROCEDURES Venous blood was collected into EDTA blood collection tubes after completion of a physical examination, and a chemiluminescent endotoxin activity assay was performed within 60 minutes of collection. Medical or surgical interventions and outcome were recorded for each horse. RESULTS Mean + or - SE endotoxin activity was 0.16 + or - 0.05 for healthy horses, 0.18 + or - 0.07 for the NSIRS group, and 0.53 + or - 0.05 for the SIRS group and was significantly different among the groups. Mean endotoxin activity was significantly higher in the SIRS group than in the NSIRS group and the healthy group. No significant difference between the healthy and NSIRS groups was present. The higher the measured endotoxin activity, the more likely it was for horses to be euthanized. CONCLUSIONS AND CLINICAL RELEVANCE The chemiluminescent endotoxin assay was easy to use, required a short time to perform, could be completed at the patient's side, and with some modifications, may be a useful component in the clinical assessment and prognostication of horses with colic.
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Affiliation(s)
- Judith B Koenig
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
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