Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery

Yaroustovsky, Michail; Abramyan, Marina; Rogalskaya, Ekaterina; Komardina, Ekaterina

doi:10.1159/000510126

Cited by 8 publications

(6 citation statements)

References 36 publications

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“…Other authors have already studied blood purification therapies in pediatric septic shock; Kawai et al ( 31 ) used therapeutic plasma exchange (TPE) in children with multiple organ dysfunction syndrome (MODS) due to sepsis and requiring ECMO, showing an improved VIS and organ failure index after a median of three TPE cycles. Polymyxin-B hemoadsorption with PMX-05 cartridges was applied in 15 children with septic shock; the authors reported a trend towards an improvement in hemodynamics after two sessions of therapy, although inotropic agent requirements did not change over time ( 32 ). More recently, Saetang et al described the use of PMX-20R (a modified polymyxin-B cartridge circuit for pediatric use) in 6 children and reported a significant reduction in PELOD-2 and VIS scores after two sessions of therapy ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

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

Bottari,

Guzzo,

Cappoli

et al. 2023

Front. Pediatr.

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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).

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Section: Discussionmentioning

confidence: 99%

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

Bottari,

Guzzo,

Cappoli

et al. 2023

Front. Pediatr.

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“…Методы экстракорпоральной гемокоррекции широко применяются в комплексной терапии критических состояний, обусловленных инфекционной патологией и сепсисом, однако, в силу недостаточного количества рандомизированных клинических исследований, до сих пор не относятся к методам терапии первого уровня доказательности, а число исследований, посвященных применению этих методов у пациентов детского возраста, в настоящее время ограничено [13,14].…”

Section: актуальностьunclassified

Prolonged venous hemodiafiltration and hemoperfusion with polymixin in fulminant meningococcal disease: A case report

Serednyakov,

Aleksandrovich,

Pshenisnov

et al. 2023

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Fulminate meningococcal infection is one of the most formidable life-threatening conditions in children, accompanied by a high probability of complications and adverse outcomes, including disability, irreversible damage to the central nervous system, and death. The key link in the pathogenesis of this condition is the massive release of endotoxins by the pathogen and total damage to the endothelium of all vessels, which underlies the development of septic shock and all complications. The use of extracorporeal hemocorrection methods is one of the most effective methods of treating fulminate meningococcal infection; however, despite the undoubted therapeutic effect, they are not included in the recommendations of a high level of evidence and are rarely used in routine clinical practice and, in most cases, only in the terminal phase of the disease. The study presented the characteristics of the course of generalized meningococcal infection in a 7-year-old child, including intensive care measures. Particular attention was paid to assessing the severity of the condition and the effectiveness of extracorporeal hemocorrection methods. The child’s condition upon admission to the intensive care unit was 11 points according to the pSOFA scale, which indicated the presence of decompensated multiorgan dysfunction and was the basis for prolonged venovenous hemodiafiltration. Based on the results of the endotoxin activity assay (0.67 units), hemoperfusion with polymyxin was conducted. During therapy, the patient’s condition stabilized. Sixty-eight hours after admission, medical support for hemodynamics was discontinued, and the parameters of invasive mechanical ventilation were reduced. On day 7 of treatment, the patient was extubated, and the events of respiratory distress did not increase over time. On day 8 after admission, with full compensation of all vital functions following ischemic damage and deep necrosis of the tissues of the lower extremities, the patient was transferred to a multidisciplinary surgical hospital for further treatment. Early informed use of extracorporeal hemocorrection techniques contributes to the rapid regression of septic shock events and recovery of the patient, demonstrating the high efficacy of the methods used and the need for further multicenter randomized trials to routinely use these therapies in clinical practice.

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“…Some reports have recently described the application of hemoadsorption in the pediatric setting. Both DH-PMX [51] and CytoSorb ® have been safely used in cases series of septic shock [52], hemophagocytic lymphohistiocytosis [53], and multi-organ failure (MOF) [54], but pediatric randomized trials are not currently planned. More information on this delicate population will need to be provided by large prospective databases.…”

Section: Cytosorb ® Hemoperfusionmentioning

confidence: 99%

Hemoperfusion in the intensive care unit

et al. 2022

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Multiple organ failure following a septic event derives from immune dysregulation. Many of the mediators of this process are humoral factors (cytokines), which could theoretically be cleared by direct adsorption through a process called hemoperfusion. Hemoperfusion through devices, which bind specific molecules like endotoxin or theoretically provide non-specific adsorption of pro-inflammatory mediators has been attempted and studied for several decades with variable results. More recently, technological evolution has led to the increasing application of adsorption due to more biocompatible and possibly more efficient biomaterials. As a result, new indications are developing in this field, and novel tools are available for clinical use. This narrative review will describe current knowledge regarding technical concepts, safety, and clinical results of hemoperfusion. Finally, it will focus on the most recent literature regarding adsorption applied in critically ill patients and their indications, including recent randomized controlled trials and future areas of investigation.

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Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery

Cited by 8 publications

References 36 publications

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

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

Prolonged venous hemodiafiltration and hemoperfusion with polymixin in fulminant meningococcal disease: A case report

Hemoperfusion in the intensive care unit

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