[Show abstract][Hide abstract] ABSTRACT: Endotoxin (Et) adsorption therapy with a column of polymyxin B-immobilized fibers (PMX) is effective in improving the partial pressure of arterial oxygen/fraction of inspired oxygen ratio (PaO(2)/FiO(2) ratio) and increasing mean arterial blood pressure (MAP) in sepsis. S100A12 and soluble receptor for advanced glycation end product (sRAGE) are useful as early markers of acute lung injury.
To investigate the effect of improving the PaO(2)/FiO(2) ratio by PMX-direct hemoperfusion (PMX-DHP) on production of S100A12 and sRAGE.
Sepsis patients after surgery for perforation of the lower gastrointestinal tract were adopted as the subjects. We retrospectively reviewed the cases of 20 patients on mechanical ventilation and continuous administration of norepinephrine. We recorded PaO(2)/FiO(2) ratio, MAP, and norepinephrine doses. S100A12, sRAGE, and Et levels were measured before and after PMX-DHP.
The PaO(2)/FiO(2) ratio and MAP improved significantly after PMX-DHP (p < 0.05). S100A12 and Et decreased significantly after PMX-DHP (p < 0.05). No differences were observed in sRAGE.
S100A12 is useful as a marker that reflected improvement in the PaO(2)/FiO(2) ratio after PMX-DHP. We consider PMX-DHP to be useful as adjunctive therapy for sepsis that reduces the Et and corrects the pathology in the early stage.
Full-text · Article · Sep 2011 · European Surgical Research
[Show abstract][Hide abstract] ABSTRACT: Glucose control is essential to avoid hypoglycemia in postoperative patients.
To conduct a preliminary examination to evaluate the feasibility of the use of an artificial pancreas for glucose control as well as the accuracy of assessment by the artificial pancreas of the insulin dose required.
Glucose control using an artificial pancreas was undertaken in 8 postoperative sepsis patients. The blood glucose level was set at 80-150 mg/dl. Blood glucose levels over time, insulin dose requirements, and occurrence of hypoglycemia (≤40 mg/dl) were recorded for each patient. The patients were divided into 2 groups based on the total insulin dose they received over the 7 days (HG, n = 4: consisting of patients who required a higher insulin dose; LG, n = 4: patients who required a lower insulin dose). The data of the 2 groups were analyzed retrospectively.
The blood glucose level before glucose control was 203.3 ± 9.9 mg/dl and could be controlled in all patients to within the target range. No hypoglycemia events were recorded for any of the patients. The insulin dose in the HG and LG groups was 21,824.8 ± 6,030.4 and 6,254.5 ± 3,402.3 mU/kg (p < 0.05).
Accurate glucose control could be achieved with the artificial pancreas.
Full-text · Article · Jun 2011 · European Surgical Research
[Show abstract][Hide abstract] ABSTRACT: The normal systemic inflammatory response to surgical stimuli often makes early diagnosis of postoperative infections difficult.
We investigated whether serum procalcitonin (PCT) levels may be a useful marker of bacterial infections in patients after invasive surgery.
The subjects were 40 patients who had undergone radical surgery for esophageal carcinoma by a right thoracoabdominal approach. Nine patients were diagnosed to have a postoperative infection during the first 7 days after surgery. Changes in serum PCT levels were compared between the group diagnosed to have postoperative infection (infection group) and the group without infection (noninfection group).
The postoperative serum PCT levels were significantly higher in the infection group than in the noninfection group (ANOVA: p < 0.01). Serum PCT peaked on postoperative day (POD) 5 in the infection group (8.7 +/- 8.2 ng/ml, mean +/- SD) and on POD 1 in the noninfection group (0.5 +/- 0.5 ng/ml). No significant differences were found between the two groups in leukocyte count, serum CRP or cytokine levels. The receiver operating characteristics (ROC) curve was constructed for infection identification. The area under the ROC curve for peak postoperative PCT was 0.968, and at a cutoff value of 2.0 ng/ml, the sensitivity was 89% and the specificity was 93%.
Serum PCT levels may be useful for the early diagnosis of postoperative infectious complications.
No preview · Article · Jan 2005 · European Surgical Research