Bottari Gabriella, Confalone Valerio, Creteur Jacques, Cecchetti Corrado, Taccone Fabio Silvio
Pediatric Intensive Care Unit, Bambino Gesuù Children's Hospital, Scientific Institute for Research, Hospitalization, Healthcare (IRCCS), 00165 Rome, Italy.
Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium.
Biomedicines. 2024 Jun 27;12(7):1435. doi: 10.3390/biomedicines12071435.
The importance of perfusion-guided resuscitation in septic shock has recently emerged. We explored whether the use of hemoadsorption led to a potential beneficial role in microvascular alterations in this clinical setting. : A pre-planned secondary analysis of a Phase-II interventional single-arm pilot study (NCT05658588) was carried out, where 17 consecutive septic shock children admitted into PICU were treated with continuous renal replacement therapy (CRRT) and CytoSorb. Thirteen patients were eligible to be investigated with sublingual microcirculation at baseline, 24, 48, 72 and 96 h from the onset of blood purification. Patients achieving a microvascular flow index (MFI) ≥ 2.5 and/or proportion of perfused vessels (PPV) exceeding 90% by 96 h were defined as . In 10/13 (77%), there was a significant improvement in MFIs ( = 0.01) and PPVs% ( = 0.04) between baseline and 24 h from the end of treatment. Eight patients displayed a high heterogenicity index (HI > 0.5) during blood purification and among these, five showed an improvement by the end of treatment (HI < 0.5). In this pilot study, we have found a potential association between CytoSorb hemoadsorption and a microcirculation improvement in pediatric patients with septic shock, particularly when this observation has been associated with hemodynamic improvement.
灌注引导复苏在感染性休克中的重要性最近已显现出来。我们探讨了血液吸附在这种临床情况下对微血管改变是否具有潜在的有益作用。：对一项II期介入性单臂试验研究（NCT05658588）进行了预先计划的二次分析，17名连续入住儿科重症监护病房（PICU）的感染性休克儿童接受了持续肾脏替代疗法（CRRT）和CytoSorb治疗。13名患者在血液净化开始后的基线、24、48、72和96小时接受舌下微循环检查。在96小时时微血管血流指数（MFI）≥2.5和/或灌注血管比例（PPV）超过90%的患者被定义为…… 10/13（77%）的患者在治疗结束后24小时时MFI（P = 0.01）和PPV%（P = 0.04）较基线有显著改善。8名患者在血液净化期间表现出高异质性指数（HI > 0.5），其中5名在治疗结束时有所改善（HI < 0.5）。在这项初步研究中，我们发现CytoSorb血液吸附与感染性休克儿科患者的微循环改善之间可能存在关联，特别是当这种观察结果与血流动力学改善相关时。
