Early Initiation of Polymyxin B–Immobilized Fiber Therapy Effective for Septic Shock after Aortic Replacement

Masanori Murakami, MD,1 Yoshitoyo Miyauchi, MD,2 Masahiko Nishida, MD,1 Haruhiko Okada, MD,1 and Kimikazu Hamano, MD3

A 76-year-old female underwent ascending aorta and partial arch replacement. She developed septic shock on postoperative day 6. She was administered dopamine, 10 µg kg−1 min−1; dobutamine, 5 µg kg−1 min−1; and norepinephrine, 0.3 µg kg−1 min−1. However, the blood pressure was 74/40 mmHg. Direct hemoperfusion using polymyxin B–immobilized fiber (PMX-DHP) was started; 3 h later, the blood pressure increased to 118/54 mmHg. Norepinephrine was stopped, and dopamine and dobutamine doses were decreased to 5 µg kg−1 min−1 3 and 12 h after completing PMX-DHP, respectively. In suspected septic shock, early PMX-DHP simultaneously with drug treatment facilitates hemodynamic improvement. (Ann Thorac Cardiovasc Surg 2007; 13: 287-289)

Key words: polymyxin B–immobilized fiber, septic shock, aortic replacement

Departments of 1Cardiovascular Surgery and 2Anesthesiology and Critical Care, Shakaihoken Tokuyama Central Hospital, Shunan, and 3Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan

Received July 25, 2006; accepted for publication December 28, 2006
Address reprint requests to Masanori Murakami, MD: Department of Cardiovascular Surgery, Shakaihoken Tokuyama Central Hospital, Kohdacho 1–1, Shunan 745–8522, Japan.