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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To evaluate, with a prospective observational study, whether continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter (PMMA-CHDF) is effective for prevention and treatment of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) on patients with severe acute pancreatitis (SAP). The study was carried out in the general intensive care unit (ICU) of a university hospital. Seventeen consecutive patients with SAP were treated in the intensive care unit and underwent PMMA-CHDF whether or not they had renal failure. ⋯ There was a significant positive correlation between blood level of IL-6 and IAP, suggesting that PMMA-CHDF improved vascular permeability through elimination of cytokines, and that it thereby decreased interstitial edema to lower IAP. Sixteen of the 17 patients were discharged from the hospital in remission from SAP without development of complications. Continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter appears to be effective for prevention and treatment of IAH in patients with SAP through the removal of causative cytokines of hyperpermeability.
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Involvement of the activation of neutrophils and vascular endothelial cells in the pathology of sepsis has recently been reported. We therefore investigated whether direct hemoperfusion (DHP) with a polymyxin B immobilized fiber column (PMX) could reduce the level of plasminogen activator inhibitor-1 (PAI-1), an index of vascular endothelial cell activation. Twelve sepsis patients satisfying the following criteria were enrolled in the study: (i) stable global oxygen metabolism (oxygen delivery index>500 mL/min/m2 and oxygen consumption index>120 mL/min/m2); (ii) abnormal tissue oxygen metabolism (PCO2 gap: gastric mucosal PCO2 minus arterial PCO2 difference>8 mm Hg); and (iii) mean blood pressure>or=60 mm Hg. ⋯ The PAI-1 value was 150+/-30.0 ng/mL before DHP with PMX, 178+/-60.0 ng/mL immediately after DHP with PMX, 90+/-22.1 ng/mL at 24 h after, 65+/-21.0 ng/mL at 48 h after, and 64+/-18.3 ng/mL 72 h after. The values were significantly lower from 48 h onward compared with baseline. These data suggest that DHP with PMX inhibits vascular endothelial cell activation.