2010 - TTS International Congress

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Complications Infections

29.7 - Endotoxin Activity Assay and Polimyxyn-B in early management of endotoxemia

Presenter: Gilnardo, Novelli, Rome, Afghanistan
Authors: Novelli G., Ferretti G., Poli L., Morabito V., Ruberto f., Rossi M., Berloco P.



G. Novelli, G. Ferretti, V. Morabito, L. Poli, F. Ruberto, M. Rossi, P. Berloco
Surgery And Transplant Organs, Sapienza University of Rome, Rome/ITALY

Body: Background: The aim of this study was to evaluate the ability of the Endotoxin Activity (EA) assay to determine the need for early intervention of endotoxemia using polymyxin-B based hemoperfusion (PMX-DHP) on septic patients. The secondary end point to highlight the major incidence of endotoxin activity in transplant patients. Methods: From April 2008 to October 2009, fourty-one patients after surgical period with diagnosis of SIRS were enrolled in this study. Cause of surgery: major abdominal surgery 22 patients(pt); liver transplant 14pt; kidney transplant 3pt and lung transplant 2pt. Nineteen patients had a high EA level (≥ 0.6) and were treated with PMX-DHP every 24 hours until the EA level was low (< 0.4). The remaining twenty-two had EA levels <0.60 and received standard therapy only. Results: Twenty-two (55%) showed a low endotoxin activity level (EA < 0.6) at the first examination. These levels did not significantly change after 24 hours except one patient. This patient showed an EA of 0.62 after 24 hours and was then shifted to the treatment group. Microbiological findings of these patients in the low endotoxin level group, showed the presence of Gram positive infections in 14 of 22 patients, 5 infections of mycetes and three fungal infections. Of the 19 patients(45%) with EA> 0.60, 25% had abdominal surgery; 70% had liver transplant; 66% kidney transplant and 50% lung transplant. Among patients showing EA≥0.6, seven patients (median EA=0.64 [0.62-0.87) required two PMX-DHP treatments, nine patients (median EA=0.845 [0.74–1.08]) required three treatments and three patients (median EA=0.985 [0.72–1.25]) required four treatments in order to reach EA<0.4 condition (median 0.328 (range [0.22-0.48]). No adverse events were observed during the hemoperfusion treatments performed. At the end of the PMX-DHP therapy, a statistically significant improvement in the hemodynamic parameters, Mean Arterial Pressure (MAP) and Heart Rate (HR), were observed. White blood cells count significantly decreased and the PaO2/FiO2 ratio increased. Median SOFA scores also decreased from 7 (range [3-13]) to 4 (range[1-12]) at the end of the therapy. Conclusion: The EA assay can identify patients eligible for PMX-DHP treatment and aids its therapeutic dosing.

Disclosure: All authors have declared no conflicts of interest.

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