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.
| Published in | American Journal of Pediatrics (Volume 5, Issue 2) |
| DOI | 10.11648/j.ajp.20190502.11 |
| Page(s) | 34-42 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2019. Published by Science Publishing Group |
Multiple Organ Failure, Pediatrics, Hyperinflammation, Plasmapheresis, Hemoadsorption, Cytosorb
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APA Style
Leonardo Milella, Maria Teresa Ficarella, Gerolmina Calabrese, Michele Sisto, Rita Luana Grieco, et al. (2019). Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series. American Journal of Pediatrics, 5(2), 34-42. https://doi.org/10.11648/j.ajp.20190502.11
ACS Style
Leonardo Milella; Maria Teresa Ficarella; Gerolmina Calabrese; Michele Sisto; Rita Luana Grieco, et al. Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series. Am. J. Pediatr. 2019, 5(2), 34-42. doi: 10.11648/j.ajp.20190502.11
AMA Style
Leonardo Milella, Maria Teresa Ficarella, Gerolmina Calabrese, Michele Sisto, Rita Luana Grieco, et al. Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series. Am J Pediatr. 2019;5(2):34-42. doi: 10.11648/j.ajp.20190502.11
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Download@article{10.11648/j.ajp.20190502.11,
author = {Leonardo Milella and Maria Teresa Ficarella and Gerolmina Calabrese and Michele Sisto and Rita Luana Grieco and Paola Moliterni and Pasquale Raimondo and Fabiana Cito and Vito Bellino and Antonio Ranieri and Mario Giordano},
title = {Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series},
journal = {American Journal of Pediatrics},
volume = {5},
number = {2},
pages = {34-42},
doi = {10.11648/j.ajp.20190502.11},
url = {https://doi.org/10.11648/j.ajp.20190502.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190502.11},
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.},
year = {2019}
}
TY - JOUR T1 - Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series AU - Leonardo Milella AU - Maria Teresa Ficarella AU - Gerolmina Calabrese AU - Michele Sisto AU - Rita Luana Grieco AU - Paola Moliterni AU - Pasquale Raimondo AU - Fabiana Cito AU - Vito Bellino AU - Antonio Ranieri AU - Mario Giordano Y1 - 2019/05/06 PY - 2019 N1 - https://doi.org/10.11648/j.ajp.20190502.11 DO - 10.11648/j.ajp.20190502.11 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 34 EP - 42 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20190502.11 AB - 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. VL - 5 IS - 2 ER -
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