Volume 5, Issue 2, June 2019, Page: 34-42
Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series
Leonardo Milella, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Maria Teresa Ficarella, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Gerolmina Calabrese, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Michele Sisto, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Rita Luana Grieco, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Paola Moliterni, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Pasquale Raimondo, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Fabiana Cito, Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy
Vito Bellino, Department of Pediatric Nephrology and Dialysis, Pediatric Hospital Giovanni XXIII, Bari, Italy
Antonio Ranieri, Department of Pediatric Nephrology and Dialysis, Pediatric Hospital Giovanni XXIII, Bari, Italy
Mario Giordano, Department of Pediatric Nephrology and Dialysis, Pediatric Hospital Giovanni XXIII, Bari, Italy
Received: Feb. 20, 2019;       Accepted: Apr. 9, 2019;       Published: May 6, 2019
DOI: 10.11648/j.ajp.20190502.11      View  95      Downloads  52
Abstract
Objective: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonatal and pediatric setting however, the application of these methods brings with it various challenges but also profound technical difficulties. Recently, a promising extracorporeal device for cytokine adsorption (CytoSorb) was introduced. However, data for its application in critically ill pediatric patients remains sparse. Design: Single center retrospective case study; Setting: Tertiary neonatal and pediatric general intensive care unit; Patients: The study comprised 10 critically ill pediatric patients; Interventions: We describe the use of CytoSorb in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in ten severely ill pediatric patients with multiple organ failures of various etiologies; Measurements: The aim was to assess the effects on the inflammatory status, hemodynamics, and clinically relevant outcome parameters as well as the feasibility and safety of CytoSorb application in pediatrics; Main Results: We observed a marked decrease in inflammatory mediators, a reduction in catecholamine dosages and an improvement in organ functions, which was particularly pronounced in patients who survived. An early onset of treatment (at best within 24-48 hours after diagnosis of sepsis) seemed to be beneficial for eventual survival. Conclusions: The present case series is the first documentation of a set of pediatric/neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in organ functions as well as safety and feasibility. Further prospective randomized controlled studies in the pediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.
Keywords
Multiple Organ Failure, Pediatrics, Hyperinflammation, Plasmapheresis, Hemoadsorption, Cytosorb
To cite this article
Leonardo Milella, Maria Teresa Ficarella, Gerolmina Calabrese, Michele Sisto, Rita Luana Grieco, Paola Moliterni, Pasquale Raimondo, Fabiana Cito, Vito Bellino, Antonio Ranieri, Mario Giordano, Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series, American Journal of Pediatrics. Vol. 5, No. 2, 2019, pp. 34-42. doi: 10.11648/j.ajp.20190502.11
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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