Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support
10.4266/kjccm.2016.31.2.123
- Author:
Sun Hye SHIN
1
;
Hyun LEE
;
Aeng Ja CHOI
;
Kylie Hae Jin CHANG
;
Gee Young SUH
;
Chi Ryang CHUNG
Author Information
1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
extracorporeal membrane oxygenation;
hemoperfusion;
polymyxin B;
myocardia diseases;
septic shock
- MeSH:
Adult;
Cardiomyopathies;
Endotoxins;
Extracorporeal Membrane Oxygenation;
Hemodynamics;
Hemoperfusion;
Humans;
Membranes;
Oxygen;
Polymyxin B;
Polymyxins;
Pyelonephritis;
Salvage Therapy;
Sepsis;
Shock;
Shock, Septic
- From:The Korean Journal of Critical Care Medicine
2016;31(2):123-128
- CountryRepublic of Korea
- Language:English
-
Abstract:
Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
