Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy.
Division of Nephrology and Dialysis, Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy.
Int J Artif Organs. 2020 Sep;43(9):587-593. doi: 10.1177/0391398820902469. Epub 2020 Jan 31.
To determine the clinical effect of continuous hemoperfusion with Cytosorb associated with standard Continuous Renal Replacement Therapy on hemodynamics and on clinically relevant outcome parameters in children with septic shock.
Retrospective analysis.
Pediatric intensive care unit.
Eight consecutive children with septic shock who received hemoperfusion with Cytosorb while on Continuous Renal Replacement Therapy.
Continuous hemoperfusion with Cytosorb (adsorber was changed every 24 h).
Vasoactive-Inotropic Score was measured before and after the extracorporeal blood purification treatment. Bedside refractory septic shock score was calculated before the onset of the extracorporeal blood purification treatment. Time course of cytokines interleukin-6, interleukin-10, and tumor necrosis factor-alpha was measured at Time 0, then every 12 h until the end of blood purification treatment (72 or 96 h). Pediatric intensive care unit survival in our cohort was 90%. Median bedside refractory septic shock score was 2.1. Patients showed improved Vasoactive-Inotropic Score following blood purification (pre: 40.00 post: 8.89 = 0.0076). Measurement of cytokines level showed a significant reduction of interleukin-6 plasma levels (7977.27-210.18 pg/mL, = 0.0077) and interleukin-10 plasma levels (from 687.19 to 36.95 pg/mL, = 0.0180). In those patients with detectable tumor necrosis factor-alpha plasma level, its reduction was not significant ( = 0.138). The median removal ratio was 80% for interleukin-6, 90% for interleukin-10, and 29% for tumor necrosis factor-alpha.
The use of Cytosorb in combination with Continuous Renal Replacement Therapy as blood purification strategy in pediatric septic shock is associated with a rapid hemodynamic stabilization in the first 48 h of treatment and a significant reduction of interleukin-6 and interleukin-10.
确定与标准连续肾脏替代疗法（CRRT）联合使用细胞吸附剂连续血液灌流（CytoSorb）对感染性休克患儿血流动力学和临床相关结局参数的临床疗效。
回顾性分析。
儿科重症监护病房（PICU）。
8 例连续接受 CytoSorb 连续血液灌流（吸附剂每 24 小时更换一次）治疗的感染性休克患儿。
CytoSorb 连续血液灌流（吸附剂每 24 小时更换一次）。
在体外血液净化治疗前后测量血管活性-正性肌力评分（Vasoactive-Inotropic Score，VIS）。在开始体外血液净化治疗前计算床边难治性感染性休克评分。在 0 时间点测量细胞因子白细胞介素-6（IL-6）、白细胞介素-10（IL-10）和肿瘤坏死因子-α（TNF-α）的时间过程，然后每 12 小时测量一次，直到血液净化治疗结束（72 或 96 小时）。本队列患儿的儿科重症监护病房（PICU）生存率为 90%。中位床边难治性感染性休克评分为 2.1 分。患者在血液净化后 VIS 得到改善（治疗前：40.00 分，治疗后：8.89 分， = 0.0076）。细胞因子水平的测量显示，IL-6 血浆水平（7977.27-210.18 pg/mL， = 0.0077）和 IL-10 血浆水平（从 687.19 降至 36.95 pg/mL， = 0.0180）显著降低。对于可检测到 TNF-α 血浆水平的患者，其降低不显著（ = 0.138）。IL-6 的中位清除率为 80%，IL-10 为 90%，TNF-α 为 29%。
在儿科感染性休克中，将 CytoSorb 与 CRRT 联合作为血液净化策略，在治疗的最初 48 小时内可迅速稳定血流动力学，并显著降低 IL-6 和 IL-10 水平。
