-Original-

The Effects of Polymyxin B-immobilized Fiber Hemoperfusion on Respiratory Impairment in Endotoxemic Pigs

Hiroyuki Koami¹, Yuichiro Sakamoto¹, Taku Miyasho², Takaharu Itami³, Jun Tamura³, Tomohito Ishizuka³, Yoshio Kawamura⁴, Kozo Nakamura³, Kenjirou Miyoshi³ and Kazuto Yamashita³

¹Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University
²Department of Veterinary Science, School of Veterinary Medicine, Rakuno Gakuen University
³Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University
⁴Department of Veterinary Pathobiology, School of Veterinary Medicine, Rakuno Gakuen University

Purpose: This study investigated the effects of direct hemoperfusion with polymyxin B-immobilized fibers (PMX-DHP) on respiratory impairment in endotoxemic pigs.
Materials and Methods: Thirteen anesthetized, mechanically ventilated pigs were divided into PMX-DHP (n=7) and control (n=6) groups. All pigs were hemodynamically monitored with the pulse index contour cardiac output (PiCCO) system (Pulsion Medical Systems, Munich, Germany) and infused intravenously with live Escherichia coli (LD50). In the PMX-DHP group, an arteriovenous extracorporeal circuit with a PMX column was applied for 30 to 150 minutes after endotoxin injection. We analyzed the laboratory data, arterial blood gas levels, and PiCCO variables (extravascular lung water [EVLW] and pulmonary vascular permeability index [PVPI]). Furthermore, we performed computed tomography of the chest in all pigs. The data were statistically analyzed with Student's t-test, the chi-square test, and the Mann-Whitney U-test.
Results: With PMX-DHP endotoxemia significantly decreased and blood pressure increased 150 minutes after endotoxin injection. PiCCO revealed more cases of decreased EVLW in the PMX-DHP group. PVPI increased after endotoxin infusion in both groups. Computed tomography showed improvements in the PMX-DHP group. The survival rate was greater in the PMX-DHP group (100%) than in the control group (71%).
Conclusion: PMX-DHP is effective for treating respiratory impairment and contributes to the decreased mortality rate in the endotoxemic pigs.

J Nippon Med Sch 2014; 81: 130-138

Keywords
polymyxin B-immobilized fiber hemoperfusion, sepsis, pulse index contour cardiac output system, extravascular lung water, pulmonary vascular permeability index

Correspondence to
Hiroyuki Koami, Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan
hkoami@cc.saga-u.ac.jp

Received, September 19, 2013
Accepted, December 13, 2013