ESPN 50th Annual Meeting

ESPN 2017


 
Treatment of severe sepsis using Polymyxin-B direct hemoperfusion (PMX-B DHP) in two pediatric patients
MATTIA PAROLIN 1 GUIDO DI GREGORIO 2 ENRICO VIDAL 1 DAVIDE MENEGHESSO 1 GERMANA LONGO 1 ELISA BENETTI 1 LUISA MURER 1

1- PEDIATRIC NEPHROLOGY DIALYSIS AND TRANSPLANTATION UNIT, DEPARTMENT FOR WOMAN AND CHILD HEALTH, UNIVERSITY OF PADUA
2- DEPARTEMENT OF ANESTHESIOLOGY, UNIVERSITY OF PADUA
 
Introduction:

 

PMX-B DHP is an extracorporeal technique used in gram negative(G-)sepsis,based upon a selective adsorption of circulating endotoxins from the blood,improving hemodynamic,organ dysfunction and 28-days mortality.

Material and methods:

 

We report two cases of pediatric patients treated with PMX-B DHP in a pediatric intensive care unit(PICU)setting.

Results:

 

Case 1:2years old male underwent 2ndliver transplantation.In 5thpost-operative day(POD)the patient developed an increase in inflammatory markers,stage 2 AKI,respiratory failure and severe hypotension,unresponsive to fluid resuscitation and vasoactive drugs.Clinical state was strongly suggestive for septic shock.Microbiological samples were collected and broad spectrum antibiotic therapy was started,but with lack of efficacy.Ematic endotoxin activity(EEA)resulted 0,67 suggesting a G- sepsis.Considering the clinical picture and antibiotic resistant sepsis,PMX-B DHP was started,with a dialysis equipment using a cartridge PMX-20R,designed for adult patients.DHP was carried out with a 4% albumin priming,Qb 70ml/min and heparin as anticoagulation.Five daily consecutive sessions(3hours each)was performed without any complications,followed by a remarkable clinical/laboratoristic improvement and EEA of 0,4.In 23rd POD children was discharged from PICU.

Case 2:3years old male with congenital heart disease.During the corrective surgical intervention the patient experienced a serious hypotension,subsequent prerenal AKI and fluid overload with need for RRT.In the 7thPOD,during the admission in PICU,a G- septic shock with a EEA of 0,71 was diagnosed.Broad spectrum antibiotic therapy was started but without any efficacy,then six daily consecutive DHP was performed using PMX-20R cartridge with a Qb 60ml/min,priming with 4% albumin and anticoagulation with heparin.The DHP was well tolerated with an improvement in the clinical conditions and a gradual weaning from vasoactive drugs and EEA of 0,4.Unfortunately the patient died after 25days because of cardiac failure.

Conclusions:

 

Nowadays,the use of extracorporeal methods based on selective adsorption are getting more and more employed in the treatment of septic shock in adult patients.Our case series seems to demonstrate the safety and efficacy of PMX-B DHP also in critically ill children.