Volume 6, Issue 3, September 2020, Page: 207-217
Our Four Years Experience of Hemoadsorption, Albumin and Heparin Treatment for Paediatric Sepsis: Let’s Give a Chance in Multifactorial Pathological Conditions
Milella Leonardo, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Cito Fabiana, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Raimondo Pasquale, Department of Anaesthesia and Intensive Care (Cardiac Surgery Unit), Policlinico di Bari, Bari, Italy
Ficarella Maria Teresa, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Moliterni Paola, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Sisto Michele, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Lasorella Maria Luigia, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Lombardi Nadia, Department of Anaesthesia and Intensive Care, University of Foggia, OO RR, Foggia, Italy
Maldera Milena, Department of Anaesthesia and Intensive Care, School of Medicine - Milano Bicocca, Milano, Italy
Calabrese Gerolmina, Pediatric Department of Anaesthesia and Intensive Care Unit (General and Post Cardiac Surgery), Giovanni XXIII Hospital - Policlinico di Bari, Bari, Italy
Received: Mar. 3, 2020;       Accepted: Mar. 30, 2020;       Published: May 28, 2020
DOI: 10.11648/j.ajp.20200603.16      View  211      Downloads  56
Abstract
Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. These techniques are applied to a relevant number of clinical situations as Sepsis, Trauma, burns, Influenza, surgery, Pancreatitis, ARDS, Life support, Liver failure. 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) has been introduced, however data for its application in critically ill pediatric patients remains sparse1. The lack of data and procedure protocols led us to take some aprioristic diagnostic and speculative decisions only from a scientific point of view: “in primis” when we decided for the first time in a pediatric patient to use this "Cytosorb Absorber", a device not registered and delivered for toddlers; second when it was clear that we could extend its use to not conventional disease therapeutic strategies; third when we decided to give to “Cytosorb” use the appellation and indication of “rescue treatment”. These results are interesting for the scientific community, but further research is needed.
Keywords
CRRT, Apheresis, Cytosorb, MOF, Sepsis, Albumin, ECMO
To cite this article
Milella Leonardo, Cito Fabiana, Raimondo Pasquale, Ficarella Maria Teresa, Moliterni Paola, Sisto Michele, Lasorella Maria Luigia, Lombardi Nadia, Maldera Milena, Calabrese Gerolmina, Our Four Years Experience of Hemoadsorption, Albumin and Heparin Treatment for Paediatric Sepsis: Let’s Give a Chance in Multifactorial Pathological Conditions, American Journal of Pediatrics. Vol. 6, No. 3, 2020, pp. 207-217. doi: 10.11648/j.ajp.20200603.16
Copyright
Copyright © 2020 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.
Reference
[1]
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.
[2]
Milella L and Ficarella MT. First application of CVVHDF, plasmapheresis and “Cytosorb A Bsorber” to solve a pediatric Haemophagocitic Histyocitosis case. Crimson publisher. December 8, 2017.
[3]
P. Raimondo; MT. Ficarella; P. Moliterni; M. Sisto; F. Cito; G. Calabrese; L. Milella. Use of Cytosorbin a Pediatric patient with septic shock due to streptococcal arthritis. Case of the week. 18/06/2019.
[4]
Rimmele T, Kellum JA: Clinical review: blood purification forsepsis. Crit Care 2011; 15: 205.
[5]
Trager K, Fritzler D, Fischer G, et al: Treatment of postcardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs 2016; 39: 141-6.
[6]
Datzmann T, Trager K: Extracorporeal membrane oxygenation and cytokine adsorption. J Thorac Dis 2018; 10: S653-S660.
[7]
Honore PM, Jacobs R, Joannes-Boyau O, et al: Newly designed CRRT membranes for sepsis and SIRS-- a pragmatic approach for bedside intensivists summarizing the more recent advances: a systematic structured review. ASAIO J 2013; 59: 99-106.
[8]
Eyre M, Hacohen Y, Barton C, et al: Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm. Dev Med Child Neurol 018; 60: 765-779.
[9]
Milella L: Neonatal and Pediatric General and Cardiac Anaesthesia and ICU: wath‟s new in 2017/2018? –Bari Pediatric Hospital Experience-Italy." Journal of Pediatrics and Neonatal Care 2018; 8: 00309.
[10]
Bonavia A, Groff A, Karamchandani K, et al: Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review. Blood Purif 2018; 46: 337-349.
[11]
Song M, Winchester J, Albright RL, et al: Cytokine removal with a novel adsorbent polymer. Blood Purif 2004; 22: 428-34.
[12]
Gruda MC, Ruggeberg KG, O'Sullivan P, et al: Broad adsorption of sepsis-related PAMP and DAMP molecules, mycotoxins, and cytokines from whole blood using CytoSorb® sorbent porous polymer beads. PLoS One 2018; 13: e0191676. American Journal of Pediatrics 2019; 5 (2): 34-42 42.
[13]
Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med 2003; 348: 138-50.
[14]
Spittler A, Razenberger M, Kupper H, et al: Relationship between interleukin-6 plasma concentration in patients with sepsis, monocyte phenotype, monocyte phagocytic properties, and cytokine production. Clin Infect Dis 2000; 31: 1338-42.
[15]
Kellum JA, Kong L, Fink MP, et al: Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study. Arch Intern Med 2007; 167: 1655-63.
[16]
Kellum JA, Song M, Venkataraman R: Hemoadsorption removes tumor necrosis factor, interleukin-6, and interleukin-10, reduces nuclear factor-kappaB DNA binding, and improves short-term survival in lethal endotoxemia. Crit CareMed 2004; 32: 801-5.
[17]
Hetz H, Berger R, Recknagel P et al: Septic shock secondary to β-hemolytic streptococcus-induced necrotizing fasciitis treated with a novel cytokine adsorption therapy. Int J Artif Organs 2014; 37: 422-6.
[18]
Bruenger F, Kizner L, Weile J, et al: First successful combination of ECMO with cytokine removal therapy in cardiogenic septic shock: a case report. Int J Artif Organs 2015; 38: 113-6.
[19]
Pinsky MR, Vincent JL, Deviere J, et al: Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality. Chest 1993; 103: 565-75.
[20]
Saraiva M, O'Garra A: The regulation of IL-10 production by immune cells. Nat Rev Immunol 2010; 10: 170-81.
[21]
Friesecke S, Stecher SS, Gross S, et al: Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study. J Artif Organs2017; 20: 252-259.
[22]
Trager K, Skrabal C, Fischer G, et al: Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series. Int J.
[23]
Artif Organs 2017; 40: 240-249.
[24]
David S, Thamm K, Schmidt BMW, et al: Effect of extracorporeal cytokine removal on vascular barrier functioning a septic shock patient. J Intensive Care 2017; 5: 12.
[25]
Hinz B, Jauch O, Noky T, et al: CytoSorb, a novel therapeutic approach for patients with septic shock: a case report. Int J Artif Organs 2015; 38: 461-4.
[26]
Trager K, Schutz C, Fischer G, et al: Cytokine Reduction in the Setting of an ARDS-Associated Inflammatory Response with Multiple Organ Failure. Case Rep Crit Care 2016; 9852073.].
[27]
Kogelmann K, Jarczak D, Scheller M, et al: Hemoadsorption by CytoSorb in septic patients: a case series. Crit Care 2017; 21: 74.
[28]
Kumar A, Roberts D, Wood KE, et al: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589-96.
[29]
Rivers E, Nguyen B, Havstad S, et al: Early Goal-Directed.
[30]
Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-77.
[31]
Kohei Nagumo, Motohiko Tanaka, Victor Tuan Giam Chuang, Hiroko Setoyama, Hiroshi Watanabe, NaoyukiYamada, Kazuyuki Kubota, Motoko Tanaka, Kazutaka Matsushita, Akira Yoshida Hideaki Jinnouchi, Makoto Anraku, Daisuke Kadowaki, Yu Ishima, Yutaka Sasaki, Masaki Otagiri and Toru Maruyama; Cysteinylated Human Serum Albumin Is a Sensitive Plasma Marker in Oxidative Stress-Related Chronic Diseases; PLoS One. 2014; 9 (1): e85216. Published online 2014 Jan 8. doi: 10.1371/journal.pone.0085216PMCID: PMC3885702PMID: 24416365Cys34.
[32]
Del Giudice, Dicko, Galantini; Structural response of Human Albumin to Oxidation: Biological Buffer to local formation of Hypoclorite; Pavel-Boeringher-2019.
[33]
Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero, Fanizza C, Caspani L, Faenza S, grasselli G, Iapichino G, Antonelli M, Parrini V, fiore G, Latini R and Gattinoni L for the ALBIOS Study Investigators. Albumine Replacement in Patients with severe Sepsis or Septic Shock. N England J Med 2014.
Browse journals by subject