Pediatric Section – Research Article

Morin L.a,b,c· Charbel R.a· Cousin V.L.a· Marais C.a,b· Claude C.a,b· Barreault S.a,b· Durand P.a· Miatello J.a,b,c· Tissières P.a,b,c

Author affiliations

aPediatric Intensive Care and Neonatal Medicine, Bicêtre Hospital, AP-HP Paris Saclay University, Le Kremlin-Bicêtre, France
bInstitute of Integrative Biology of the Cell, CNRS, CEA, Paris Saclay University, Gif-sur-Yvette, France
cFHU SEPSIS, AP-HP, Inserm, Paris Saclay University, Le Kremlin-Bicêtre, France

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Start free trial

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

Received: January 14, 2023
Accepted: March 09, 2023
Published online: April 27, 2023

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 3

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Introduction: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. As such, circulating cytokines and danger- and pathogen-associated molecular patterns (such as endotoxins) are recognized as central in the pathogenesis of sepsis and organ dysfunction. Removing these compounds by extracorporeal blood filtration, commonly considered blood purification, may improve the septic patients’ condition. This study aimed to assess the vaso-inotropic support evolution over time in pediatric patients with vasoplegic shock treated with oXiris©. Methods: All patients aged below 18 years admitted at the Paris Saclay University Quaternary Pediatric Intensive Care Unit with vasoplegic shock and acute kidney injury and treated with oXiris© between October 2017 and January 2020 were included. The vaso-inotropic score and the 28-day mortality were assessed. Improvement under treatment was defined as a 50% decrease in the vaso-inotropic score following 24 h of oXiris© therapy. Results: Eleven pediatric patients aged 2–15 years and weighing 11–60 kg were admitted with vasoplegic shock and acute kidney injury. They received thirteen sessions of oXiris© therapy for septic shock (N = 7) and liver failure (N = 6). Eight patients did not improve their condition during the session, and five ultimately died (37.5% survival). Five patients improved, decreasing their inotropic support by >50% in 24 h. Among them, four survived (80%). Conclusion: Hemofiltration and extracorporeal blood purification with oXiris© can be used in pediatric patients with vasoplegic shock with rapid improvement in hemodynamics in selected patients.

© 2023 S. Karger AG, Basel

References Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016 Feb 23;315(8):801–10. Rosadini CV, Kagan JC. Early innate immune responses to bacterial LPS. Curr Opin Immunol. 2017 Feb 1;44:14–9. Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Med Exp. 2018 May 4;6(1):12. Bhatt GC, Sethi SK, Mehta I, Nair N, Chakraborty R, Sharma B, et al. Literature review of the efficacy of high-volume hemofiltration in critically ill pediatric patients. Blood Purif. 2022;51(8):649–59. Snow TAC, Littlewood S, Corredor C, Singer M, Arulkumaran N. Effect of extracorporeal blood purification on mortality in sepsis: a meta-analysis and trial sequential analysis. Blood Purif. 2021;50(4–5):462–72. Broman ME, Hansson F, Vincent JL, Bodelsson M. Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: a randomized crossover double-blind study. PLoS One. 2019;14(8):e0220444. Rimmelé T, Assadi A, Cattenoz M, Desebbe O, Lambert C, Boselli E, et al. High-volume haemofiltration with a new haemofiltration membrane having enhanced adsorption properties in septic pigs. Nephrol Dial Transplant. 2009 Feb;24(2):421–7. Pickkers P, Vassiliou T, Liguts V, Prato F, Tissieres P, Kloesel S, et al. Sepsis management with a blood purification membrane: European experience. Blood Purif. 2019;47(Suppl 3):1–9. Chevret L, Durand P, Lambert J, Essouri S, Balu L, Devictor D, et al. High-volume hemofiltration in children with acute liver failure. Pediatr Crit Care Med. 2014 Sep;15(7):e300–305. Morin L, Ray S, Wilson C, Remy S, Benissa MR, Jansen NJG, et al. Refractory septic shock in children: a European society of paediatric and neonatal intensive care definition. Intensive Care Med. 2016 Oct 5;42(12):1948–57. Davidson J, Tong S, Hancock H, Hauck A, da Cruz E, Kaufman J. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012 Apr 14;38(7):1184–90. Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010 Mar;11(2):234–8. Leclerc F, Leteurtre S, Duhamel A, Grandbastien B, Proulx F, Martinot A, et al. Cumulative influence of organ dysfunctions and septic state on mortality of critically ill children. Am J Respir Crit Care Med. 2005 Feb 15;171(4):348–53. Fitzgerald JC, Basu RK, Fuhrman DY, Gorga SM, Hassinger AB, Sanchez-Pinto LN, et al. Renal dysfunction criteria in critically ill children: the PODIUM Consensus Conference. Pediatrics. 2022;149(1 Suppl 1):S66–S73. Schwindenhammer V, Girardot T, Chaulier K, Grégoire A, Monard C, Huriaux L, et al. oXiris® use in septic shock: experience of two French centres. Blood Purif. 2019;47(Suppl 3):1–7. Guan M, Wang H, Tang X, Zhao Y, Wang F, Zhang L, et al. Continuous renal replacement therapy with adsorbing filter oXiris in acute kidney injury with septic shock: a retrospective observational study. Front Med. 2022;9:789623. Phan PH, Nguyen DT, Dao NH, Nguyen HTT, Vu AV, Hoang ST, et al. Case report: successful treatment of a child with COVID-19 reinfection-induced fulminant myocarditis by cytokine-adsorbing oXiris® hemofilter continuous veno-venous hemofiltration and extracorporeal membrane oxygenation. Front Pediatr. 2022;10:946547. Sutherland SM, Goldstein SL, Alexander SR. The prospective pediatric continuous renal replacement therapy (ppCRRT) registry: a critical appraisal. Pediatr Nephrol. 2014 Nov;29(11):2069–76. Bottari G, Lorenzetti G, Severini F, Cappoli A, Cecchetti C, Guzzo I. Role of hemoperfusion with CytoSorb associated with continuous kidney replacement therapy on renal outcome in critically III children with septic shock. Front Pediatr. 2021;9:718049. Lumlertgul N, Srisawat N. The haemodynamic effects of oXiris haemofilter in septic shock patients requiring renal support: a single-centre experience. Int J Artif Organs. 2021 Jan 1;44(1):17–24. Turani F, Candidi F, Barchetta R, Grilli E, Belli A, Papi E, et al. Continuous renal replacement therapy with the adsorbent membrane oXiris in septic patients: a clinical experience. Crit Care. 2013;17(S2):P63. Kang K, Luo Y, Gao Y, Zhang J, Wang C, Fei D, et al. Continuous renal replacement therapy with oXiris filter may not be an effective resolution to alleviate cytokine release syndrome in non-AKI patients with severe and critical COVID-19. Front Pharmacol. 2022;13:817793. Supady A, Weber E, Rieder M, Lother A, Niklaus T, Zahn T, et al. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial. Lancet Respir Med. 2021 May 14;9(7):755–762. Dominik A, Stange J. Similarities, differences, and potential synergies in the mechanism of action of Albumin Dialysis using the MARS Albumin Dialysis device and the CytoSorb hemoperfusion device in the treatment of liver failure. Blood Purif. 2021;50(1):119–28. Ocskay K, Tomescu D, Faltlhauser A, Jacob D, Friesecke S, Malbrain M, et al. Hemoadsorption in “liver indication’-analysis of 109 patients” data from the CytoSorb international registry. J Clin Med. 2021 Nov 5;10(21):5182. Ankawi G, Neri M, Zhang J, Breglia A, Ricci Z, Ronco C. Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls. Crit Care. 2018 Oct 25;22(1):262. Zhou Y, Wu C, Ouyang L, Peng Y, Zhong D, Xiang X, et al. Application of oXiris-continuous hemofiltration adsorption in patients with sepsis and septic shock: a single-centre experience in China. Front Public Health. 2022;10:1012998. Roberts JA, Lefrant JY, Lipman J. What’s new in pharmacokinetics of antimicrobials in AKI and RRT?Intensive Care Med. 2017;43(6):904–6. David S, Thamm K, Schmidt BMW, Falk CS, Kielstein JT. Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient. J Intensive Care. 2017;5:12. Shum HP, Chan KC, Kwan MC, Yan WW. Application of endotoxin and cytokine adsorption haemofilter in septic acute kidney injury due to Gram-negative bacterial infection. Hong Kong Med J. 2013 Dec;19(6):491–7. Raina R, Agrawal N, Kusumi K, Pandey A, Tibrewal A, Botsch A. A meta-analysis of extracorporeal anticoagulants in pediatric continuous kidney replacement therapy. J Intensive Care Med. 2022 May;37(5):577–94. Buccione E, Guzzi F, Colosimo D, Tedesco B, Romagnoli S, Ricci Z, et al. Continuous renal replacement therapy in critically ill children in the pediatric intensive care unit: a retrospective analysis of real-life prescriptions, complications, and outcomes. Front Pediatr. 2021;9:696798. Article / Publication Details

Received: January 14, 2023
Accepted: March 09, 2023
Published online: April 27, 2023

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 3

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.