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Arai T, Mori Y, Yoshizaki S, Ando R, Natori S, Morishita S, Otani M, Numata A, Osanai H. Polymyxin B and low-dose hydrocortisone treatment in a patient with uroseptic shock in a rural health unit. Oxf Med Case Reports 2021; 2021:omab109. [PMID: 34858624 PMCID: PMC8633641 DOI: 10.1093/omcr/omab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Sepsis has a high mortality rate; thus, in the intensive care unit, early diagnosis and adjunctive treatments are crucial. However, generally, most patients with sepsis from rural area initially visit the emergency department at a rural hospital and are managed in general medical wards in Japan. Here we report on an 81-year-old Japanese female manifesting septic shock caused by the upper urinary tract infection of extended-spectrum beta-lactamase-producing Escherichia coli secondary to the left ureter obstruction by the urothelial carcinoma. Broad-spectrum antibiotics were administered. Although critical for the source control of infection, drainage of the ureteropelvic junction could not be performed immediately because of catecholamine-resistant hypotension. Hence, we administered polymyxin B-immobilized fiber column direct hemoperfusion, followed by low-dose hydrocortisone administration. After 8 hours of infusion, she recovered from the septic shock and successfully underwent emergency percutaneous nephrostomy. This presented strategy may provide a new resolution of catecholamine-resistant patients in urosepsis.
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Affiliation(s)
- Toshio Arai
- Department of Internal Medicine, Furano Kyokai Hospital, Hokkaido, Japan.,Department of Parasitology, National Institute of Infectious Disease, Tokyo, Japan
| | - Yuichiro Mori
- Department of Internal Medicine, Furano Kyokai Hospital, Hokkaido, Japan
| | - Saori Yoshizaki
- General Education Center, Kyorin University Hospital, Tokyo, Japan
| | - Ryo Ando
- Department of Gastroenterology, Teine Keijin-Kai Hospital, Hokkaido, Japan
| | - Shunsuke Natori
- Department of Cardiology, Furano Kyokai Hospital, Hokkaido, Japan
| | - Shun Morishita
- Department of Urology, Furano Kyokai Hospital, Hokkaido, Japan
| | - Miyu Otani
- Department of Urology, Furano Kyokai Hospital, Hokkaido, Japan
| | - Atsushi Numata
- Department of Urology, Furano Kyokai Hospital, Hokkaido, Japan
| | - Hiroaki Osanai
- Department of Urology, Furano Kyokai Hospital, Hokkaido, Japan
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Tani T, Shimizu T, Tani M, Shoji H, Endo Y. Anti-endotoxin Properties of Polymyxin B-immobilized Fibers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1145:321-341. [PMID: 31364085 PMCID: PMC7123644 DOI: 10.1007/978-3-030-16373-0_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Polymyxin B is an antibiotic that shows strong bactericidal activity against Gram-negative bacteria, by binding to and inactivating endotoxin. Systemic administration of polymyxin B in humans is restricted because of its nephrotoxicity and neurotoxicity, and this compound was therefore considered a strong candidate ligand for the extracorporeal selective adsorption of circulating endotoxin in the blood. Toraymyxin® is a direct hemoperfusion column that uses polymyxin B attached to an insoluble carrier to bind endotoxin in the blood. In 1994, the Japanese National Health Insurance system approved the use of Toraymyxin for the treatment of endotoxemia and septic shock.In this chapter, we will review the development, clinical use, and efficacy of Toraymyxin, examine the structure of the Toraymyxin column, and comment on the current position of Toraymyxin in the treatment of severe sepsis and septic shock. We will also highlight some potential new applications of Toraymyxin for pulmonary diseases.
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Affiliation(s)
- Tohru Tani
- Biomedical Innovation Center, Shiga University of Medical Science, Otsu, Shiga, Japan. .,Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hisataka Shoji
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshihiro Endo
- Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Shiga, Japan
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Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, Marx G, Putensen C, Spies C, Jörres A, Quintel M, Engel C, Kellum JA, Kuhlmann MK. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS One 2017; 12:e0187015. [PMID: 29084247 PMCID: PMC5662220 DOI: 10.1371/journal.pone.0187015] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 10/10/2017] [Indexed: 12/16/2022] Open
Abstract
Objective We report on the effect of hemoadsorption therapy to reduce cytokines in septic patients with respiratory failure. Methods This was a randomized, controlled, open-label, multicenter trial. Mechanically ventilated patients with severe sepsis or septic shock and acute lung injury or acute respiratory distress syndrome were eligible for study inclusion. Patients were randomly assigned to either therapy with CytoSorb hemoperfusion for 6 hours per day for up to 7 consecutive days (treatment), or no hemoperfusion (control). Primary outcome was change in normalized IL-6-serum concentrations during study day 1 and 7. Results 97 of the 100 randomized patients were analyzed. We were not able to detect differences in systemic plasma IL-6 levels between the two groups (n = 75; p = 0.15). Significant IL-6 elimination, averaging between 5 and 18% per blood pass throughout the entire treatment period was recorded. In the unadjusted analysis, 60-day-mortality was significantly higher in the treatment group (44.7%) compared to the control group (26.0%; p = 0.039). The proportion of patients receiving renal replacement therapy at the time of enrollment was higher in the treatment group (31.9%) when compared to the control group (16.3%). After adjustment for patient morbidity and baseline imbalances, no association of hemoperfusion with mortality was found (p = 0.19). Conclusions In this patient population with predominantly septic shock and multiple organ failure, hemoadsorption removed IL-6 but this did not lead to lower plasma IL-6-levels. We did not detect statistically significant differences in the secondary outcomes multiple organ dysfunction score, ventilation time and time course of oxygenation.
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Affiliation(s)
- Dirk Schädler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- * E-mail:
| | - Christine Pausch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Daniel Heise
- Centre of Anaesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Andreas Meier-Hellmann
- Department of Anesthesiology and Intensive Care Medicine, HELIOS Klinikum, Erfurt, Germany
| | - Jörg Brederlau
- Department of Intensive Care Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Norbert Weiler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, RWTH University Hospital Aachen, Aachen, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
| | - Claudia Spies
- Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany
| | - Achim Jörres
- Department of Medicine I - Nephrology, Transplantation & Medical Intensive Care, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany
| | - Michael Quintel
- Centre of Anaesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - John A. Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Martin K. Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Shimizu T, Miyake T, Kitamura N, Tani M, Endo Y. Endotoxin adsorption: Direct hemoperfusion with the polymyxin B-immobilized fiber column (PMX). Transfus Apher Sci 2017; 56:682-688. [PMID: 28923774 DOI: 10.1016/j.transci.2017.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Toraymyxin® is a medical device developed to adsorb circulating endotoxins in the blood using direct hemoperfusion therapy for patients with septic shock. In 1994, the Japanese National Health Insurance system approved the use of Toraymyxin for the treatment of endotoxemia and septic shock. Since then, Toraymyxin has been safely used in more than 100,000 cases in emergency and intensive care units in Japan. Toraymyxin is currently available for use in the clinical setting in 14 countries worldwide. In this study, we reviewed and introduced the development, clinical use, and efficacy of Toraymyxin and commented on its anticoagulant use and cartridge clotting issue in the treatment of severe sepsis and septic shock. We also highlighted potential new applications of Toraymyxin for longer duration therapy and pulmonary diseases.
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Affiliation(s)
- Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Naomi Kitamura
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yoshihiro Endo
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan
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Shimizu T, Miyake T, Tani M. History and current status of polymyxin B-immobilized fiber column for treatment of severe sepsis and septic shock. Ann Gastroenterol Surg 2017; 1:105-113. [PMID: 29863114 PMCID: PMC5881300 DOI: 10.1002/ags3.12015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/26/2017] [Indexed: 12/02/2022] Open
Abstract
Toraymyxin® (Toray Medical Co., Ltd, Tokyo, Japan) has been developed as a direct hemoperfusion column that contains polymyxin B‐immobilized fiber to bind endotoxins in patients’ blood. Toraymyxin was approved by the Japanese National Health Insurance system for the treatment of endotoxemia and septic shock in 1994. Since then, PMX (defined as direct hemoperfusion with Toraymyxin) has been safely used in more than 100 000 cases in emergency and intensive care units in Japan. Toraymyxin is currently available for use in clinical settings in 12 countries outside of Japan. We reviewed and analyzed the development, clinical use, and efficacy of Toraymyxin, and assessed the current status of Toraymyxin use for the treatment of severe sepsis and septic shock. Our review shows that PMX appeared to be effective in improving hemodynamics and respiratory function in septic shock requiring emergency abdominal surgery. Recent large‐scale ranomized controlled trialscould not demonstrate whether prognosis is improved by PMX. However, the latest meta‐analysis revealed that PMX significantly decreased mortality in patients with severe sepsis and septic shock. Combination of PMX with continuous hemodiafiltration and longer duration of PMX might be an effective strategy to improve survival in such patients.
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Affiliation(s)
- Tomoharu Shimizu
- Department of Surgery Shiga University of Medical Science Shiga Japan
| | - Toru Miyake
- Department of Surgery Shiga University of Medical Science Shiga Japan
| | - Masaji Tani
- Department of Surgery Shiga University of Medical Science Shiga Japan
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Payen DM, Guilhot J, Launey Y, Lukaszewicz AC, Kaaki M, Veber B, Pottecher J, Joannes-Boyau O, Martin-Lefevre L, Jabaudon M, Mimoz O, Coudroy R, Ferrandière M, Kipnis E, Vela C, Chevallier S, Mallat J, Robert R. Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med 2015; 41:975-84. [PMID: 25862039 PMCID: PMC4477725 DOI: 10.1007/s00134-015-3751-z] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/11/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE To test whether the polymyxin B hemoperfusion (PMX HP) fiber column reduces mortality and organ failure in peritonitis-induced septic shock (SS) from abdominal infections. METHOD Prospective, multicenter, randomized controlled trial in 18 French intensive care units from October 2010 to March 2013, enrolling 243 patients with SS within 12 h after emergency surgery for peritonitis related to organ perforation. The PMX HP group received conventional therapy plus two sessions of PMX HP. Primary outcome was mortality on day 28; secondary outcomes were mortality on day 90 and a reduction in the severity of organ failures based on Sequential Organ Failure Assessment (SOFA) scores. RESULTS PRIMARY OUTCOME day 28 mortality in the PMX HP group (n = 119) was 27.7 versus 19.5% in the conventional group (n = 113), p = 0.14 (OR 1.5872, 95% CI 0.8583-2.935). Secondary endpoints: mortality rate at day 90 was 33.6% in PMX-HP versus 24% in conventional groups, p = 0.10 (OR 1.6128, 95% CI 0.9067-2.8685); reduction in SOFA score from day 0 to day 7 was -5 (-11 to 6) in PMX-HP versus -5 (-11 to 9), p = 0.78. Comparable results were observed in the predefined subgroups (presence of comorbidity; adequacy of surgery, <2 sessions of hemoperfusion) and for SOFA reduction from day 0 to day 3. CONCLUSION This multicenter randomized controlled study demonstrated a non-significant increase in mortality and no improvement in organ failure with PMX HP treatment compared to conventional treatment of peritonitis-induced SS.
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Affiliation(s)
- Didier M Payen
- Department of Anesthesia and Critical Care, SAMU, Lariboisière University Hospital, University Paris 7 Denis Diderot, Paris, France,
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:66-73. [PMID: 19225308 DOI: 10.1097/moo.0b013e32832406ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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