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Removal of 2‐Arachidonylglycerol by Direct Hemoperfusion Therapy With Polymyxin B Immobilized Fibers Benefits Patients With Septic Shock

Arachidonylethanolamide (AEA) and 2‐arachidonylglycerol (2‐AG) are endocannabinoids involved in septic shock, and 8‐epi prostaglandin F2α (F2‐isoprostane) is a biomarker of oxidative stress in biological systems. Because the antibiotic polymyxin B absorbs endocannabinoids as well as endotoxins, direct hemoperfusion therapy with polymyxin B‐immobilized fibers (PMX‐DHP) decreases serum levels of endocannabinoids. To investigate the features of sepsis and determine the proper use of PMX‐DHP, we measured the changes in levels of endocannabinoids and F2‐isoprostane in patients with septic shock. Twenty‐six patients with septic shock, including those with septic shock induced by peritonitis, underwent laparotomy for drainage. Endocannabinoids absorption with PMX‐DHP was examined in two groups of patients: patients whose mean arterial blood pressure (mABP) had increased more than 20 mm Hg (responder group; N = 13); and patients iwhose mABP did not increase or had increased no more than 20 mm Hg (non‐responder group; N = 13). Levels of AEA did not change after PMX‐DHP in either the non‐responder or responder groups, whereas levels of 2‐AG decreased significantly after PMX‐DHP in the responder group, but not in the non‐responder group. F2‐isoprostane gradually increased after PMX‐DHP treatment; on the other hand, levels of F2‐isoprostane remained constant in the responder group. Patients with septic shock are under considerable oxidative stress, and 2‐AG plays an important role in the cardiovascular status of these patients. The removal of 2‐AG by PMX‐DHP benefits patients with septic shock by stabilizing cardiovascular status and decreasing long‐term oxidative stress.