Base de dados : MEDLINE
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  1 / 3265 MEDLINE  
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[PMID]:29297645
[Au] Autor:Yaroustovsky MB; Abramyan MV; Krotenko NP; Komardina EV
[Ti] Título:Methods of Molecular Transfusion in the Intensive Therapy of Critical States.
[So] Source:Vestn Ross Akad Med Nauk;71(4):281-7, 2016.
[Is] ISSN:0869-6047
[Cp] País de publicação:Russia (Federation)
[La] Idioma:eng
[Ab] Resumo:Development of extracorporeal blood purification acquires greater significance in the intensive care of multiple organ failures (MOF) with all the pathophysiological aspects of its constituent parts. MOF are the main cause of mortality among critically ill patients and treatment of these patients require significant investment. The purpose of the implementation of extracorporeal blood correction techniques today is multiple organ support therapy (MOST). Early extracorporeal therapy is used only in the treatment of renal failure. Today extracorporeal techniques are increasingly being used to replace the functions of various organs and systems. MOST includes diffusion, convection, filtration, sorption, apheresis methodic. They affect the molecular and electrolyte composition of blood, allow to correct, repair, replace, and maintain homeostasis in severe multiorgan dysfunction. Extracorporeal new molecular technologies have been successfully applied in the intensive care of severe heart and respiratory failure, acute kidney injury and acute hepatic dysfunction, in the treatment of severe sepsis, metabolic disorders, the correction of immune imbalance.
[Mh] Termos MeSH primário: Hemofiltração/métodos
Hemoperfusão/métodos
Insuficiência de Múltiplos Órgãos/terapia
Plasmaferese/métodos
[Mh] Termos MeSH secundário: Cuidados Críticos/métodos
Cuidados Críticos/tendências
Estado Terminal/terapia
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.15690/vramn680


  2 / 3265 MEDLINE  
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[PMID]:29245231
[Au] Autor:Iguchi S; Yamaguchi N; Takami H; Komatsu T; Ookubo H; Sekii H; Inoue K; Okazaki S; Okai I; Maruyama S; Nomura T; Sugita M
[Ad] Endereço:aDepartment of Emergency and Critical Care MedicinebDepartment of Cardiology, Juntendo University Nerima HospitalcDepartment of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
[Ti] Título:Higher efficacy of direct hemoperfusion using coated activated-charcoal column for disopyramide poisoning: A case report.
[So] Source:Medicine (Baltimore);96(49):e8755, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Cases of severe disopyramide poisoning are rare and few have been reported. We report a case in which activated-charcoal column hemoperfusion was dramatically effective for life-threatening disopyramide poisoning. PATIENT CONCERNS: A teenage girl who had overdosed on disopyramide (total dose, 4950 mg) was brought to our hospital. She was resuscitated from short period cardiopulmonary arrest and subsequently showed severe cardiogenic shock and ventricular arrhythmia. DIAGNOSES: Disopyramide poisoning (self-evident). INTERVENTIONS: As hemodynamics remained unstable after providing percutaneous cardiopulmonary support and intra-aortic balloon pumping, we attempted direct hemoperfusion using a coated activated-charcoal hemoperfusion column. OUTCOMES: Hemodynamics including electrocardiography and serum disopyramide concentration were dramatically improved, and the patient was ambulatory by hospital day 14. LESSONS: Because disopyramide has low molecular weight and a small distribution volume, blood purification is considered to be the most effective therapy. We selected direct hemoperfusion for relatively high protein-binding rate. In fact, clinical status was dramatically improved, and the calculated half-life of the direct hemoperfusion phase was the shortest of all phases. In cases of severe or life-threatening disopyramide poisoning, blood purification therapy including direct hemoperfusion using a coated activated-charcoal column should be performed.
[Mh] Termos MeSH primário: Antiarrítmicos/envenenamento
Disopiramida/envenenamento
Overdose de Drogas/terapia
Hemoperfusão/métodos
[Mh] Termos MeSH secundário: Adolescente
Antídotos/uso terapêutico
Carvão Vegetal/uso terapêutico
Feminino
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Arrhythmia Agents); 0 (Antidotes); 16291-96-6 (Charcoal); GFO928U8MQ (Disopyramide)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008755


  3 / 3265 MEDLINE  
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[PMID]:28704509
[Au] Autor:Wang Y; Chen Y; Mao L; Zhao G; Hong G; Li M; Wu B; Chen X; Tan M; Wang N; Lu Z
[Ad] Endereço:Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
[Ti] Título:Effects of hemoperfusion and continuous renal replacement therapy on patient survival following paraquat poisoning.
[So] Source:PLoS One;12(7):e0181207, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mortality in patients with paraquat (PQ) poisoning is related to plasma PQ levels. Concentrations lower than 5,000 ng/mL are considered critical but curable. This study assessed the effects of hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the survival of PQ-poisoned patients with plasma PQ levels below 5,000ng/mL. We analyzed the records of 164 patients with PQ poisoning who were treated at the First Affiliated Hospital of Wenzhou Medical University in China between January 2011 and May 2015. We divided these patients into six sub-groups based on baseline plasma PQ levels and treatment, compared their clinical characteristics, and analyzed their survival rates. Patient sub-groups did not differ in terms of age, sex, time between poisoning and hospital admission, or time to first gavage. Biochemical indicators improved over time in all sub-groups following treatment, and the combined HP and CRRT treatment yielded better results than HP or CRRT alone. Fatality rates in the three treatment sub-groups did not differ among patients with baseline plasma PQ levels of 50-1,000 ng/mL, but in patients with 1,000-5,000 ng/mL levels, the mortality rate was 59.2% (HP treatment group), 48% (CRRT treatment group), and 37.9% (combined treatment group). Mortality rates were higher 10-30 days after hospitalization than in the first 10 days after admission. In the early stages of PQ poisoning, CRRT is effective in reducing patient fatality rates, particularly when combined with HP. Our data could be useful in increasing survival in acute PQ poisoning patients.
[Mh] Termos MeSH primário: Hemoperfusão
Paraquat/envenenamento
Envenenamento/mortalidade
Envenenamento/terapia
Terapia de Substituição Renal
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
China/epidemiologia
Feminino
Hidratação/métodos
Hemoperfusão/métodos
Hemoperfusão/mortalidade
Hemoperfusão/estatística & dados numéricos
Herbicidas/envenenamento
Seres Humanos
Masculino
Meia-Idade
Terapia de Substituição Renal/métodos
Terapia de Substituição Renal/mortalidade
Terapia de Substituição Renal/estatística & dados numéricos
Estudos Retrospectivos
Taxa de Sobrevida
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Herbicides); PLG39H7695 (Paraquat)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0181207


  4 / 3265 MEDLINE  
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[PMID]:28682903
[Au] Autor:Huang J; Zhang W; Li X; Feng S; Ye G; Wei H; Gong X
[Ad] Endereço:aDepartment of Gastroenterology bDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
[Ti] Título:Acute abrin poisoning treated with continuous renal replacement therapy and hemoperfusion successfully: A case report.
[So] Source:Medicine (Baltimore);96(27):e7423, 2017 Jul.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Abrin is a highly toxic protein obtained from the seeds of Abrus precatorius, but poisoning due to ingestion of A precatorius is extremely rare in China. PATIENT CONCERNS: A 16-year-old girl, perfectly healthy before, was admitted to the department of gastroenterology owing to intentional ingestion of 10 crushed A precatorius seeds, with multiple episodes of somnolent and anxious mental status, vomiting, abdominal pain, diarrhea, hematochezia, and hematuria. DIAGNOSIS: Acute abrin poisoning. INTERVENTIONS: We immediately took effective measures including gastric lavage, purgation, gastric acid suppression by proton pump inhibitor (PPI), liver protection, hemostasis, blood volume and electrolytes resuscitation, continuous renal replacement therapy (CRRT), and hemoperfusion (HP). OUTCOMES: Her unwell mental status was improved to the point at which she became conscious and relaxed. The symptoms of vomiting, abdominal pain, diarrhea, hematochezia, and hematuria disappeared gradually. The girl eventually made an excellent recovery with no complications at her 3-month follow-up. LESSONS: The combination of CRRT and HP is an efficient measure in the treatment of abrin poisoning for which there is no specific antidote. This is the first reported case of an abrin poisoning patient successfully treated by CRRT plus HP. Our experience will be useful to other physicians in managing patients of acute abrin poisoning in the future.
[Mh] Termos MeSH primário: Abrina/envenenamento
Abrus/envenenamento
Hemoperfusão
Terapia de Substituição Renal
[Mh] Termos MeSH secundário: Adolescente
Feminino
Seres Humanos
Intenção
Sementes/envenenamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
1393-62-0 (Abrin)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007423


  5 / 3265 MEDLINE  
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[PMID]:28640122
[Au] Autor:Dong H; Weng YB; Zhen GS; Li FJ; Jin AC; Liu J
[Ad] Endereço:Emergency Internal Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
[Ti] Título:Clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning and prognosis analysis after rescue.
[So] Source:Medicine (Baltimore);96(25):e7237, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study reports the clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning, and analyzes the prognosis after rescue.The general data of 68 patients with severe organophosphorus poisoning treated in our hospital were retrospectively analyzed. These patients were divided into 2 groups: treatment group, and control group. Patients in the control group received routine emergency treatment, while patients in the treatment group additionally received hemoperfusion plus hemodialysis on the basis of routine emergency treatment. The curative effects in these 2 groups and the prognosis after rescue were compared.Compared with the control group, atropinization time, recovery time of cholinesterase activity, recovery time of consciousness, extubation time, and length of hospital stay were shorter (P < .05); the total usage of atropine was significantly lower (P < .05); Glasgow Coma Score was significantly higher (P < .05); acute physiology and chronic health score (APACHE II) was significantly lower (P < .05); and mortality and poisoning rebound rate was significantly lower (P < .05) in the treatment group.Hemoperfusion and hemodialysis on the basis of routine emergency treatment for critical patients with organophosphorus poisoning can improve rescue outcomes and improve the prognosis of patients, which should be popularized.
[Mh] Termos MeSH primário: Tratamento de Emergência
Hemoperfusão
Intoxicação por Organofosfatos/terapia
Diálise Renal
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Tratamento de Emergência/efeitos adversos
Feminino
Escala de Coma de Glasgow
Hemoperfusão/efeitos adversos
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Intoxicação por Organofosfatos/complicações
Intoxicação por Organofosfatos/diagnóstico
Intoxicação por Organofosfatos/mortalidade
Prognóstico
Diálise Renal/efeitos adversos
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007237


  6 / 3265 MEDLINE  
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[PMID]:28609698
[Au] Autor:Vu AP; Nguyen TN; Do TT; Doan TH; Ha TH; Ta TT; Nguyen HL; Hauser PC; Nguyen TAH; Mai TD
[Ad] Endereço:Poison Control Center, Bach Mai Hospital, 78 Giai Phong road, Dong Da, Hanoi, Viet Nam; Department of Analytical Chemistry, Faculty of Chemistry, VNU University of Science, Vietnam National University, Hanoi - 19 Le Thanh Tong, Hanoi, Viet Nam(1).
[Ti] Título:Clinical screening of paraquat in plasma samples using capillary electrophoresis with contactless conductivity detection: Towards rapid diagnosis and therapeutic treatment of acute paraquat poisoning in Vietnam.
[So] Source:J Chromatogr B Analyt Technol Biomed Life Sci;1060:111-117, 2017 Aug 15.
[Is] ISSN:1873-376X
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The employment of a purpose-made capillary electrophoresis (CE) instrument with capacitively coupled contactless conductivity detection (C D) as a simple and cost-effective solution for clinical screening of paraquat in plasma samples for early-stage diagnosis of acute herbicide poisoning is reported. Paraquat was determined using an electrolyte composed of 10mM histidine adjusted to pH 4 with acetic acid. A detection limit of 0.5mg/L was achieved. Good agreement between results from CE-C D and the confirmation method (HPLC-UV) was obtained, with relative errors for the two pairs of data better than 20% for 31 samples taken from paraquat-intoxicated patients. The results were used by medical doctors for identification and prognosis of acute paraquat poisoning cases. The objective of the work is the deployment of the developed approach in rural areas in Vietnam as a low-cost solution to reduce the mortality rate due to accidental or suicidal ingestion of paraquat.
[Mh] Termos MeSH primário: Eletroforese Capilar/métodos
Paraquat/sangue
Envenenamento
[Mh] Termos MeSH secundário: Condutividade Elétrica
Hemoperfusão
Seres Humanos
Limite de Detecção
Paraquat/envenenamento
Envenenamento/sangue
Envenenamento/diagnóstico
Envenenamento/terapia
Reprodutibilidade dos Testes
Vietnã
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
PLG39H7695 (Paraquat)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE


  7 / 3265 MEDLINE  
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[PMID]:28501124
[Au] Autor:Yeh YC; Yu LC; Wu CY; Cheng YJ; Lee CT; Sun WZ; Tsai JC; Lin TY; NTUH Center of Microcirculation Medical Research (NCMMR)
[Ad] Endereço:Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
[Ti] Título:Effects of endotoxin absorber hemoperfusion on microcirculation in septic pigs.
[So] Source:J Surg Res;211:242-250, 2017 May 01.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Endotoxins contribute to systemic inflammatory response and microcirculatory dysfunctions under conditions of sepsis. Polymyxin B hemoperfusion (PMX-HP) is used to remove circulating endotoxins and improve clinical outcomes. This study aims to investigate the effect of PMX-HP on microcirculation in septic pigs. MATERIALS AND METHODS: By using a septic pig model, we tested the hypothesis that PMX-HP can correct intestinal microcirculation, tissue oxygenation saturation, and histopathologic alterations. A total of 18 male pigs were divided into three groups: (1) sham; (2) sepsis (fecal peritonitis); and (3) sepsis + PMX-HP groups. A sidestream dark field video microscope was used to record microcirculation throughout the terminal ileal mucosa, colon mucosa, kidney surface, and sublingual area. A superficial tissue oxygenation monitor employing the light reflectance spectroscopy technique was used to measure the tissue oxygen saturation. Hematoxylin and eosin staining was used for histologic examination. RESULTS: The perfused small vessel density and tissue oxygen saturation of the ileal mucosa at 6 h were higher in the sepsis + PMX-HP group than those in the sepsis group. The fluid amount and norepinephrine infusion rate between the sepsis group and sepsis + PMX-HP groups did not differ significantly. The histologic score for the ileal mucosa was lower in the sepsis + PMX-HP group than that in the sepsis group. Finally, the urine output was higher in the sepsis + PMX-HP group than it was in the sepsis group. CONCLUSIONS: This study demonstrates that PMX-HP attenuates microcirculatory dysfunction, tissue desaturation, and histopathologic alterations in the ileal mucosa in septic pigs.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Hemoperfusão/métodos
Microcirculação
Polimixina B/uso terapêutico
Sepse/terapia
[Mh] Termos MeSH secundário: Animais
Biomarcadores/sangue
Endotoxinas/sangue
Íleo/patologia
Íleo/fisiopatologia
Mucosa Intestinal/patologia
Mucosa Intestinal/fisiopatologia
Masculino
Sepse/sangue
Sepse/patologia
Sepse/fisiopatologia
Suínos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Biomarkers); 0 (Endotoxins); 1404-26-8 (Polymyxin B)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170515
[St] Status:MEDLINE


  8 / 3265 MEDLINE  
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[PMID]:28445237
[Au] Autor:Chang T; Tu YK; Lee CT; Chao A; Huang CH; Wang MJ; Yeh YC
[Ad] Endereço:1Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.2Department of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
[Ti] Título:Effects of Polymyxin B Hemoperfusion on Mortality in Patients With Severe Sepsis and Septic Shock: A Systemic Review, Meta-Analysis Update, and Disease Severity Subgroup Meta-Analysis.
[So] Source:Crit Care Med;45(8):e858-e864, 2017 Aug.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Several studies have reported a survival benefit for polymyxin B hemoperfusion treatment in patients with severe sepsis and septic shock. However, recently, a propensity-matched analysis and a randomized controlled trial reported no survival benefit for polymyxin B hemoperfusion treatment. We performed an up-to-date meta-analysis to determine the effect of polymyxin B hemoperfusion treatment on mortality in patients with severe sepsis and septic shock. DATA SOURCES: PubMed, Embase, and Cochrane Library were searched from inception to May 2016. STUDY SELECTION: Studies investigating the effect of polymyxin B hemoperfusion on mortality were considered eligible. We searched for terms related to severe sepsis and septic shock and terms related to polymyxin B hemoperfusion. DATA EXTRACTION: The following data were extracted from the original articles: the name of the first author and publication year, subjects and setting, inclusion and exclusion criteria, mean age and size of the study population, male percentage, mortality, blood pressure, Sequential Organ Failure Assessment score, pulmonary oxygenation, and levels of endotoxin and humoral cytokines. DATA SYNTHESIS: A total of 17 trials were included. The pooled risk ratio for overall mortality was 0.81 (95% CI, 0.70-0.95), favoring polymyxin B hemoperfusion (p = 0.007). Disease severity subgroup meta-analysis revealed a significant reduction of mortality in the intermediate- and high-risk groups (risk ratio, 0.84; 95% CI, 0.77-0.92 and risk ratio, 0.64; 95% CI, 0.52-0.78, respectively), but not in the low-risk group (risk ratio, 1.278; 95% CI, 0.888-1.839). The nonlinear meta-regression with restricted cubic spline showed an almost linear inverse association between the baseline mortality rate and reduction in the risk of mortality. CONCLUSION: The present study demonstrated that polymyxin B hemoperfusion treatment may reduce mortality in patients with severe sepsis and septic shock in specific disease severity subgroups.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Hemoperfusão/métodos
Polimixina B/uso terapêutico
Choque Séptico/tratamento farmacológico
Choque Séptico/mortalidade
[Mh] Termos MeSH secundário: Antibacterianos/administração & dosagem
Pressão Sanguínea
Endotoxinas/sangue
Seres Humanos
Escores de Disfunção Orgânica
Polimixina B/administração & dosagem
Sepse/mortalidade
Sepse/terapia
Índice de Gravidade de Doença
Choque Séptico/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Endotoxins); 1404-26-8 (Polymyxin B)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
170816
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170427
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002362


  9 / 3265 MEDLINE  
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[PMID]:28358803
[Au] Autor:Saito N; Sugiyama K; Ohnuma T; Kanemura T; Nasu M; Yoshidomi Y; Tsujimoto Y; Adachi H; Koami H; Tochiki A; Hori K; Wagatsuma Y; Matsumoto H
[Ad] Endereço:Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
[Ti] Título:Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection.
[So] Source:PLoS One;12(3):e0173633, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Septic shock-associated mortality in intensive care units (ICUs) remains high, with reported rates ranging 30-50%. In particular, Gram-negative bacilli (GNB), which induce significant inflammation and consequent multiple organ failure, are the etiological bacterial agent in 40% of severe sepsis cases. Hemoperfusion using polymyxin B-immobilized fiber (PMX), which adsorbs endotoxin, is expected to reduce the inflammatory sepsis cascade due to GNB. However, the clinical efficacy of this treatment has not yet been demonstrated. Here, we aimed to verify the efficacy of endotoxin adsorption therapy using PMX through a retrospective analysis of 413 patients who received broad spectrum antimicrobial treatment for GNB-related septic shock between January 2009 and December 2012 in 11 ICUs of Japanese tertiary hospitals. After aligning the patients' treatment time phases, we classified patients in two groups depending on whether PMX hemoperfusion (PMXHP) therapy was administered or not within 24 hours after ICU admission (PMXHP group: n = 134, conventional group: n = 279). The primary study endpoint was the mortality rate at 28 days after ICU admission. The mean age was 72.4 (standard deviation: 12.6) years, and the mean Sequential Organ Failure Assessment score at ICU admission was 9.9 (3.4). The infection sites included intra-abdominal (38.0%), pulmonary (18.9%), and urinary tract (32.2%), and two thirds of all patients had GNB-related bacteremia. Notably, the mortality at 28 days after ICU admission did not differ between the groups (PMXHP: 29.1% vs. conventional: 29.0%, P = 0.98), and PMXHP therapy was not found to improve this outcome in a Cox regression analysis (hazard ratio = 1.16; 95% confidence interval, 0.81-1.64, P = 0.407). We conclude that PMX-based endotoxin adsorption within 24 hours from ICU admission was not associated with mortality among patients with septic shock due to GNB. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR ID: UMIN000012748).
[Mh] Termos MeSH primário: Infecções por Bactérias Gram-Negativas/tratamento farmacológico
Polimixina B/administração & dosagem
Infecções Respiratórias/tratamento farmacológico
Choque Séptico/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Endotoxinas/administração & dosagem
Feminino
Bactérias Gram-Negativas/efeitos dos fármacos
Bactérias Gram-Negativas/patogenicidade
Infecções por Bactérias Gram-Negativas/microbiologia
Infecções por Bactérias Gram-Negativas/mortalidade
Hemoperfusão
Seres Humanos
Unidades de Terapia Intensiva
Japão
Masculino
Mortalidade
Infecções Respiratórias/microbiologia
Infecções Respiratórias/mortalidade
Choque Séptico/microbiologia
Choque Séptico/mortalidade
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Endotoxins); 1404-26-8 (Polymyxin B)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170331
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0173633


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[PMID]:28328802
[Au] Autor:Li WH; Yin YM; Chen H; Wang XD; Yun H; Li H; Luo J; Wang JW
[Ad] Endereço:Department of Kidney Disease, Yan'an Hospital Affiliated to Kunming Medical University, Nephrology, Kunming, China.
[Ti] Título:Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus.
[So] Source:Medicine (Baltimore);96(12):e6160, 2017 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study aims to investigate the efficacy and safety of neutral macroporous resin hemoperfusion in treating maintenance hemodialysis (MHD) patients with refractory uremic pruritus (RUP).Ninety patients were enrolled and were randomly divided into 3 groups: control group, experiment 1 group, and experiment 2 group. Clinical symptom scores of skin itching were recorded before and at 4 and 8 weeks after the treatment. In addition, serum parathyroid hormone (PTH), calcium (Ca), phosphorus (P), and C-reactive protein (CRP) were detected; and the calcium-phosphorus product ([Ca] × [P]) was calculated to compare the curative effect.VSA score, modified Duo pruritus score, and CRP: these indices decreased to some extent at 4 and 8 weeks after treatment in the 2 experiment groups, compared with pretreatment (P < 0.05); and differences among these 3 groups were statistically significant (P < 0.05). PTH, P, and [Ca] × [P]: these indices decreased to some extent at 4 and 8 weeks after treatment in the 2 experiment groups, compared with pretreatment (P < 0.05); and differences between the control and experiment 1 groups, as well as between the control and experiment 2 groups, were statistically significant (P < 0.05). However, the difference between the experiment 1 and experiment 2 groups were not statistically significant (P < 0.05).The effects of HA330 and HA130 resin hemoperfusion apparatus on secondary hyperparathyroidism and the disorder of calcium and phosphorus metabolism are similar. The mechanism may be related to its strong adsorption effect, and its capacity to widely remove inflammatory mediators, immune mediators, and endotoxins.
[Mh] Termos MeSH primário: Hemoperfusão/métodos
Prurido/etiologia
Prurido/terapia
Diálise Renal/efeitos adversos
Uremia/etiologia
Uremia/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Proteína C-Reativa
Cálcio/sangue
Feminino
Seres Humanos
Masculino
Meia-Idade
Hormônio Paratireóideo/sangue
Fósforo/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Parathyroid Hormone); 27YLU75U4W (Phosphorus); 9007-41-4 (C-Reactive Protein); SY7Q814VUP (Calcium)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170410
[Lr] Data última revisão:
170410
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006160



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