Korean J Crit Care Med.  2015 Aug;30(3):176-179. 10.4266/kjccm.2015.30.3.176.

Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation

• Lee YK
• Ryu JA
• Yang JH
• Park CM
• Suh GY
• Jeon K
• Chung CR

• KMID: 2227645
• DOI: http://doi.org/10.4266/kjccm.2015.30.3.176

Abstract

Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

Keyword

endotoxins; extracorporeal membrane oxygenation; hemoperfusion; polymyxin B; pyelonephritis; shock, septic

MeSH Terms

Adult
Aged
Emergency Service, Hospital
Endotoxins
Extracorporeal Membrane Oxygenation*
Hemodynamics
Hemoperfusion
Humans
Nephrectomy*
Polymyxin B
Pyelonephritis
Shock, Septic*
Endotoxins
Polymyxin B

Figure

• 

  Fig. 1. Abdomen computed tomography shows swelling and a multifocal perfusion defect of both kidneys and gas (arrow) in the right renal parenchyma. (A) Transverse computed tomography (CT) image. (B) Coronal CT image.

• 

  Fig. 2. The brief course of the patient. ICU: intensive care unit; ROSC: return of spontaneous circulation; CPR: cardiopulmonary resuscitation; PMX-DHP: direct hemoperfusion with the polymyxin B; VA ECMO: veno-arterial extracorporeal membrane oxygenation.

Reference

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