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

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


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


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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