Journal of clinical apheresis
-
Current protocols utilize systolic blood pressure (SBP) of less than 80 mmHg as objective evidence of hypotension during hemapheresis. However, tissue hypoperfusion is the pathophysiologic endpoint of low blood pressure, and mean arterial pressure (MAP), rather than SBP, is the physiologic driving force behind blood flow to organs and tissues. It is thus hypothesized that MAP is more appropriate than SBP in the assessment of hypotension and that a threshold MAP can be utilized as a sensitive indicator of hypotension during hemapheresis. ⋯ Sensitivity in the detection of hypotension was 0.09% for SBP equal to 80 mmHg and 56.81% for MAP equal to 70 mmHg. An SBP of 80 mmHg or less was therefore concluded to be a less sensitive and physiologically less appropriate measurement of hypotension than MAP. As a single value less than 70 mmHg or a series of successive measurements trending downward toward 70 mmHg, MAP provides an objective assessment of hypotension that may precede hemodynamic decompensation.
-
Clinical Trial
Direct hemoperfusion using a polymyxin B immobilized column improves acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is characterized by a high mortality rate. We have studied whether direct hemoperfusion using a polymyxin B immobilized fiber column (PMX-DHP) is effective for acute lung injury (ALI) and ARDS. Two ALI and eighteen ARDS patients were evaluated, four congestive heart failure (CHF) patients were evaluated as cardiogenic pulmonary edema, and we retrospectively compared the outcome with ten patients with ARDS who had been hospitalized between 1990 and 1998 as the untreated group. ⋯ Eight of ten patients in the untreated group died through exacerbated ARDS. In ARDS patients, PMX-DHP improved circulatory disturbance and oxygenation despite the underlying diseases. The mortality improved compared with that before induction of PMX-DHP.