Evaluation of Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange, in Severe Sepsis or Septic Shock in Critically Ill Children

Abstract

Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged <18 years who were admitted to two paediatric intensive care units. Demographic data and reason for hospitalization were recorded. In addition, vital signs, haemogram parameters, and biochemistry results were recorded at 0 h and after 24 h of CRRT. Patients were compared according to whether they underwent CRRT or TPE; mortality between the two treatment groups was also compared. Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p < 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE.

Case Series: Efficacy and Safety of Hemoadsorption With HA-330 Adsorber in Septic Pediatric Patients With Cancer

“…Moreover, other authors were against HVHF over standard hemofiltration in children with septic shock or sepsis-associated organ dysfunction (15). PE can potentially improve organ function in septic patients; however, a multicenter retrospective study including patients younger than 18 years did not show any decrease in mortality in both patients with continuous renal replacement therapy and PE usage (16). Additionally, PE can lead to a deficiency of coagulation factors and hypoalbuminemia, in addition to further risk of infections.…”

Evaluation of COVID-19 Patients in The Pediatric Critical Care Unit

“…It has been suggested that CRRT and TPE can be used in patients with sepsis to reduce cytokine storm. 6,[11][12][13] However, TPE treatment in children with COVID-19 has not been reported in the literature. In 2009, Patel et al 12 reported that three pediatric patients with severe H1N1 influenza pneumonia and ARDS fully recovered after TPE treatment.…”

“…3 Therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) are extracorporeal procedures that can improve organ function in patients with sepsis and septic shock. 6 COVID-19 and plasmapheresis in children have not been adequately studied. In addition, no pediatric studies (or cases) have simultaneously evaluated the extracorporeal techniques, CRRT and TPE, in severe COVID-19 patients.…”

Continuous renal replacement therapy in critically ill children: single-center experience

“…Fluid overload (FO) is the biggest trouble in critically ill children when renal dysfunction develops. Because FO is harmful to all organs especially cardiovascular and respiratory system; cardiovascular disorders, pulmonary edema, hypotension, and severe hypoxemia are seen when FO is over 10% [1][2][3][4][5]. Therefore, we must intervene AKI and FO.…”