Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
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The polymyxin B immobilized fiber column (PMX) has been used to treat septic shock patients since 1994 under the Japanese health insurance system. In 1997, the results of the first multicenter clinical study enrolling 42 patients were published, showing a significant reduction in the plasma endotoxin level of the survivors, whilst there was no change with the non-survivors, following treatment with PMX. Body temperature, blood pressure and hemodynamic abnormalities were significantly improved after PMX treatment. ⋯ Possible mediators include endogenous cannabinoids, such as macrophage-derived anandamide, and platelet-derived 2-arachidonyl glyceride (2-AG) and tetrahydrobiopterin (BH4), an essential cofactor for inducible NO synthase. The interaction between PMX and activated monocytes may suggest an alternative mechanism for the improvement in patient condition following PMX treatment. Further studies are needed to clarify the mechanisms of PMX treatment and to strengthen the scientific basis of this treatment.
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In the intensive care unit, apheresis therapy (including plasma exchange, selective immunoadsorption and -affinity and detoxification by hemoperfusion) is limited to certain disease entities. Temporary insertion of large-bore central venous catheters is necessary for efficient performance of apheresis therapy. ⋯ Early and delayed complications are briefly discussed. Appropriate selection of the catheter insertion site, the catheter type, strictly aseptic insertion procedures and optimal care of catheter and insertion site are essential to avoid complications.