Title:
Association Active C Protein / haemoperfusion on adsorbent cartridge with “B Polymyxin”, in a patient affected by acute kidney failure (AKF) and sepsis.

Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B. ;Ricciardi B.

' ne '' ' ne '' ; 3. Chair of Nefrology of Messina University. Italy

E-mail address corresponding author:
biagioricciardi@virgilio.it

Background:
The association “Active C Protein” (interacting protein among coagulation factors / inflammation mediators) and direct haemoperfusion on adsorbent cartridge, carrier of immobilized “B Polymyxin” (able for a selective removal of endotoxins by the blood circulation), was recently applied in the possibility to confirm their active synergism.

Methods:
This protocol, was applied on a male, aged 55, B.W: 125 Kgs, recently and urgently operated for strangulated laparocele with intestinal loop exposition and effusion of semidigested material in peritoneal cavity. The clinical conditions of the patient in Reanimation Unit, were in rapid worsening and after 24 hours, for the appearance of anuria and acute Kidney failure, was necessary to perform a substitutive treatment by traditional Polisulphone CVVH low flux with 150ml/min Qb, reinfusion 50 ml/min., fluids removal 400 gr/h, continuous heparin, about 750-1000 U.I./h. In the same time a very serious sepsis, showed by severe hypotension, increment of white blood cells > 18000 and body temperature > 38.5°C, started. This clinical situation carried us to perform the Protocol with “Active C Protein” in continuous intravenous infusion at the standard dose of 24 mcg/Kg of body weight, for 96 hours, plus 2 haemoperfusions of 2 hours each, on “Polymyxin B Cartdridge” (Toraymyxin PMX) (100ml/min Qb), followed by standard CVVH.

Results:
During the treatment, an increment of the Systolic blood pressure from 80 mm Hg, under continuous infusion of vasoactive amine at high dosage, at about 120 mmHg without pharmacological therapy, and a reduction of the body temperature from 38.5°C to 36,0°C, was observed, always with W.B.C. 18000±3000 (neutrophils at 88%), without any additional increment in the 48/72 hours successive the protocol ending

Conclusion:
Even if in our experience this observation is of a single case, the use of active C protein plus the haemoperfusion with Polymyxin B cartridge in a post surgical patient, allowed an improvement of the effects of antibiotic therapy, the normalization of the body temperature in the whole period of observation, the stabilization of cardiac haemodynamics, with consequent better compliance to the CVVH. Giving a clear run to further studies, the use of this protocol may open a new ways in the treatment of patients suffering from serious generalized sepsis at very high risk, reducing the traditional pharmacological load and allowing a safer acute kidney failure extracorporeal treatment.

Subject:
New Technologies

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