Treatment of endotoxin shock due to gram-negative bacteremia using extracorporeal circulation.

概要

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The effectiveness and significance of the various therapeutic methods of extracorporeal circulation were assessed in an experimental model of septic endotoxin shock. After sepsis was produced in 30 puppies by intravenously injecting 5×109CFU/ml/kg of E. coli, on-line plasma exchange, conventional plasma exchange, charcoal plasma perfusion, hemofiltration, and sham perfusion were performed for 2hr. As a result, 4 of the 5 puppies in the on-line plasma exchange group and one of the 5 in the conventional plasma exchange group survived; the others all died. In the on-line plasma exchange group, the number of E. coli decreased to 2.5×10CFU/ml at the end of the treatment, while it was 1.3×103CFU/ml in the sham perfusion group. The endotoxin concentration was also reduced significantly, while plasma opsonin activity was remarkably elevated. These results suggest the significance of achieving the elimination of endotoxin in blood and an increase in plasma opsonin activity simultaneously in the treatment of septic endotoxin shock.