Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

Abstract

Cytokine adsorber (CytoSorb) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis and septic shock and to reduce blood myoglobin, unconjugated bilirubin, and conjugated bilirubin. In this article we present the case of a nine-month-old male infant who was admitted to the NICU due to sepsis after cardiac surgery, Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure and renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemadsorption with CytoSorb. HDF was safe and effective from the first day for urea removal, but the patient's bilirubin levels kept increasing gradually, culminating on the 9th day with a maximum value of 54 mg/dL of total bilirubin and 31.67 mg/dL of direct bilirubin when we performed hemadsorption with CytoSorb. Over the 49-hour period of hemadsorption, the total bilirubin value decreased from 54 to 14 mg/dL, and the patient's general status improved considerably accompanied by a rapid drop of aminotransferases. Hemodynamic status has been improved as well and inotropes dropped rapidly. The patient's ventilation settings improved during CytoSorb treatment permitting weaning the patient from mechanical ventilation after five days of hemadsorption. The patient was discharged home after 34 days of hospitalization, in a good general status.

Successful application of CytoSorb®hemadsorption in an immunocompromised teenager with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis

“…There was an improvement in hyperbilirubinemia, vasopressor need in 48th hour of CH, and rapid drop of aminotransferase which rose back to their previous values on termination of CH. 18…”

CytoSorb® hemoadsorption and mechanical circulatory support in a newborn with refractory shock after congenital heart surgery

“…Beyond the temporal association, the contributing role of CytoSorb ® in this remarkable improvement is conceivable. There are increasing numbers of paediatric reports describing the successful use of CytoSorb ® in different clinical settings but all related to inflammatory processes [10][11][12][13] (https://literature.CytoSorb-therapy.com/). This new medical device seems to be able to dramatically improve hemodynamic situations and allow weaning of vasopressor support in a few hours.…”

Extracorporeal membrane oxygenation and cytokine adsorption

“…A case of a 9-month-old infant reported the successful use of hemoadsorption therapy with Cytosorb ® in combination with continuous hemodiafiltration due to sepsis after cardiac surgery with multi organ failure (40). A relevant decrease of catecholamine doses, as well as aminotransferase plasma levels and bilirubin (total and direct) plasma levels was observed.…”