A pilot study: a combined therapy using polymyxin-B hemoperfusion and extracorporeal membrane oxygenation for acute exacerbation of interstitial pneumonia

Main Article Content

Junji Itai
Shinichiro Ohshimo
Yoshiko Kida
Kohei Ota
Yasumasa Iwasaki
Nobuyuki Hirohashi
Francesco Bonella
Josune Guzman
Ulrich Costabel
Nobuoki Kohno
Koichi Tanigawa

Keywords

Lung-protective ventilation, Acute respiratory failure, Fibrosis, KL-6

Abstract

Background: Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) might be beneficial for treating acute exacerbation (AE) of interstitial pneumonia (IP). Venovenous extracorporeal membranous oxygenation (VV-ECMO) is an emerging tool to avoid ventilator-induced lung injury. This is a report presenting the first three patients with AE of IP treated with a combined therapy of PMX-DHP and VV-ECMO.

Case presentation: Patient 1 was a 68-year-old male with acute interstitial pneumonia, patient 2 a 67-year-old male with AE of idiopathic pulmonary fibrosis, and patient 3 a 61-year-old female with AE of collagen vascular disease-associated interstitial pneumonia. All patients were severely hypoxemic and required mechanical ventilation. A combined therapy using PMX-DHP and VV-ECMO was initiated with support of intravenous corticosteroids and antibiotics. Radiological findings, oxygenation and laboratory findings markedly improved and all patients survived without severe complications.

Conclusion: A combined therapy of PMX-DHP and VV-ECMO might be a therapeutic option for AE of IP.
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