Background. Refractory septic shock (RSS) requiring major vasopressor support is associated with high mortality, especially in Gram-negative infections. The study aim was to describe hemodynamics, organ failure, and clinical outcomes in high-dose vasopressor therapy (HDVT) RSS patients treated with Polymyxin B hemoperfusion (PMX-HP) as rescue therapy. Methods. We retrospectively analyzed 52 patients, unresponsive to conventional therapy, treated with two sessions of PMX-HP requiring HDVT (norepinephrine and/or epinephrine requirement (NEP+EP) >= 0.5 mu g/kg/min), >= 2 organ failures, and suspected/confirmed Gram-negative infection from any source. Results. At baseline, mean arterial pressure (MAP) was 80 13 mmHg and NEP+EP requirement was 1.11+/-0.56 mu g/kg/min. After two PMX-HP sessions, at 72 h, MAP significantly increased and NEP+EP requirement decreased respectively by 12% and 76%. Pulmonary and renal function also improved significantly. Thirty patients (58%) showed a >= 50% reduction in NEP+EP dose within only 24 h after the first PMX-HP session (early responders), and 22 did not or died from irreversible shock in the same time frame (early non-responders). The 30-day hospital mortality was 29%; it was 16% in early responders and 45% in early non-responders. On multivariate analysis, SAPS II score, vasopressin, and central venous pressure significantly affected 30-day hospital mortality. Conclusion. This is the first study describing the use of PMX-HP as a rescue therapy in RSS patients with HDVT and MOF. Our results suggest a possible role for PMX-HP in improving hemodynamics, organ function, and mortality in RSS, with a 30-day survival of up to 70%.

Rescue therapy with Polymyxin B hemoperfusion in high dose vasopressor therapy Refractory Septic Shock / G. Monti, V. Terzi, A. Calini, F. Di Marco, D. Cruz, M. Pulici, P. Brioschi, S. Vesconi, R. Fumagalli, G. Casella. - In: MINERVA ANESTESIOLOGICA. - ISSN 1827-1596. - 81:5(2015), pp. 516-525.

Rescue therapy with Polymyxin B hemoperfusion in high dose vasopressor therapy Refractory Septic Shock

V. Terzi
Secondo
;
A. Calini;F. Di Marco;
2015

Abstract

Background. Refractory septic shock (RSS) requiring major vasopressor support is associated with high mortality, especially in Gram-negative infections. The study aim was to describe hemodynamics, organ failure, and clinical outcomes in high-dose vasopressor therapy (HDVT) RSS patients treated with Polymyxin B hemoperfusion (PMX-HP) as rescue therapy. Methods. We retrospectively analyzed 52 patients, unresponsive to conventional therapy, treated with two sessions of PMX-HP requiring HDVT (norepinephrine and/or epinephrine requirement (NEP+EP) >= 0.5 mu g/kg/min), >= 2 organ failures, and suspected/confirmed Gram-negative infection from any source. Results. At baseline, mean arterial pressure (MAP) was 80 13 mmHg and NEP+EP requirement was 1.11+/-0.56 mu g/kg/min. After two PMX-HP sessions, at 72 h, MAP significantly increased and NEP+EP requirement decreased respectively by 12% and 76%. Pulmonary and renal function also improved significantly. Thirty patients (58%) showed a >= 50% reduction in NEP+EP dose within only 24 h after the first PMX-HP session (early responders), and 22 did not or died from irreversible shock in the same time frame (early non-responders). The 30-day hospital mortality was 29%; it was 16% in early responders and 45% in early non-responders. On multivariate analysis, SAPS II score, vasopressin, and central venous pressure significantly affected 30-day hospital mortality. Conclusion. This is the first study describing the use of PMX-HP as a rescue therapy in RSS patients with HDVT and MOF. Our results suggest a possible role for PMX-HP in improving hemodynamics, organ function, and mortality in RSS, with a 30-day survival of up to 70%.
Shock, septic; Hemoperfusion; Norepinephrine; Gram-negative bacterial infections; Multiple organ failure
Settore MED/41 - Anestesiologia
2015
16-ott-2014
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/260210
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