Impact of CytoSorb and CKRT on hemodynamics in pediatric patients with septic shock: the PedCyto study

Abstract

BackgroundThere is a lack of data to support the use of hemoadsorption in pediatric septic shock. The aim of our study was to assess the effectiveness and safety of CytoSorb therapy in this setting.MethodsPhase II interventional single arm pilot study in which 17 consecutive children admitted with septic shock who required continuous kidney replacement therapy (CKRT) and weighed ≥10 kg were included. A CytoSorb (CytoSorbents Inc, New Jersey, USA) hemoadsorption cartridge was added to the CKRT every 24 h for a maximum of 96 h. A control group of 13 children with septic shock treated with CKRT but not hemoadsorption at Children's Hospital Bambino Gesù and enrolled in the EuroAKId register was selected as an historical cohort. The primary outcome of the study was a reduction in vasopressor or inotrope dose of >50% from baseline by the end of CytoSorb therapy. Secondary outcomes included hemodynamic and biological changes, changes in severity scores, and 28-day mortality.ResultsThere were significant decreases in the Vasoactive Inotropic Score (VIS) and the Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score at 72 and 96 h from the start of the CytoSorb therapy compared to baseline; the reductions were larger in the hemoadsorption group than in the control group (historical cohort). 28-day mortality was lower, although not significantly, in the hemoadsorption group when compared to the control group (5/17 [29%] vs. 8/13 [61%] OR 0.26 [95% CI: 0.05–1.2]; p = 0.08).ConclusionsCytoSorb therapy may have some benefits in pediatric patients with septic shock. Future larger randomized trials are needed in this setting. Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT05658588, identifier (Clinicaltrials.gov NCT05658588).

The Sublingual microcirculation in critically ill children with septic shock undergoing hemoadsorption: a pilot study

“…The study protocol underwent review and approval by the local Ethics Committee in July 2019 (Ethics Committee Reference: N376). Informed written consent was obtained from the next of kin or legal guardian for each patient enrolled in the study (9).…”

“…In our recent study involving children with septic shock, we observed a signi cant reduction in the Vasoactive Inotropic Score (VIS) and Pediatric Logistic Organ Dysfunction (PELOD-2) score at 72 and 96 hours following initiation of CytoSorb therapy, when compared to baseline. Importantly, these reductions were more pronounced in th hemoadsorption group than in a historical cohort of pediatric patients who underwent continuous renal replacement therapy (CRRT) alone (9). Furthermore, we embarked on an exploration of whether the observed hemodynamic improvements were accompanied by corresponding changes in microcirculation during CytoSorb and CRRT therapy in the same cohort of pediatric patients.…”