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[Continuous blood purification in the treatment of pediatric septic shock]
Zhi-chun Feng1, Ping Chang, Shao-hua Tao
1Pediatric Institute of Beijing Military Area of Chinese People's Liberation Army, Beijing 100700, China.
Insights
Continuous blood purification (CBP) effectively treats pediatric septic shock by improving oxygenation and stabilizing blood pressure. This method helps correct metabolic acidosis and enhances tissue perfusion in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Intensive Care Medicine
Background:
- Pediatric septic shock is a life-threatening condition requiring immediate and effective interventions.
- Continuous blood purification (CBP) is an emerging therapy for critically ill children.
- Understanding the mechanisms and efficacy of CBP in pediatric septic shock is crucial.
Purpose of the Study:
- To evaluate the effectiveness of continuous blood purification (CBP) in treating pediatric septic shock.
- To explore the underlying mechanisms by which CBP impacts physiological parameters in septic shock.
Main Methods:
- Nine pediatric patients with septic shock underwent continuous veno-venous hemofiltration (CVVH), a form of CBP.
- Treatment involved specific hemofilters and extracorporeal circuits, with pre- and post-dilution replacement solutions.
- Key parameters including blood gases, biochemical markers, medium molecule substance (MMS) levels, oxygenation, and hemodynamic status were monitored.
Main Results:
- Patients showed significant improvements in blood pH, base excess, and reduced MMS levels after 24 hours of CVVH.
- Oxygenation (PO2/FiO2), capillary refill time (CRT), and urine output improved, indicating enhanced tissue perfusion.
- Vasopressor dosages for adrenaline and dopamine were substantially reduced, demonstrating hemodynamic stabilization.
Conclusions:
- Continuous blood purification (CBP) is an effective treatment for pediatric septic shock.
- CBP improves oxygenation, corrects metabolic acidosis, and stabilizes blood pressure.
- The therapy enhances tissue perfusion and removes harmful medium molecule substances, contributing to patient recovery.
Objective:
To investigate the efficacy of continuous blood purification (CBP) and to explore its mechanism in the treatment of pediatric septic shock.
Methods:
Nine children weighted 3.1 kg - 14.0 kg with septic shock were treated with continuous veno-venous hemofiltration (CVVH) which is also referred to as CBP with blood access of double-lumen hemodialysis catheter of 6.5 to 8Fr inserted via central vein, hemofilters of Minifilter plus (for children with body weight < 5 kg) or AV400s (for children with body weight > or = 5 kg), child's type extracorporeal circuit vessel and heparin anticoagulation. The replacement solution was delivered pre-dilution after 3 to 4 hours' post-dilution. The blood gas, clinical biochemical items, medium molecule substance (MMS) concentration in blood as well as capillary refill time (CRT), BP, urine output, vasopressors dosage were examined at a set of time points from the beginning to the end of the CVVH.
Results:
Of the 9 children, 6 had acute renal failure (ARF), 3 had acute respiratory distress syndrome (ARDS), 5 were blood culture positive and all the 9 needed vasopressors to keep BP before CVVH. The blood pH was 7.14 +/- 0.23, base excess (BE) was -11.3 +/- 4.25 mmol/L, MMS was 3532 +/- 519 U/L, PO2/FiO2 was 188 +/- 33, CRT > 5 s, urine output was 0.85 +/- 0.52 ml/(kg.hr) and the adrenalin dosage 1.36 +/- 0.48 microg/(kg.min), and dopamine 16.35 +/- 3.27 microg/(kg.min) before CVVH. The patients' condition was improved much as demonstrated by pH 7.38 +/- 0.16, BE -0.28 +/- 1.37 mmol/L, MMS 2576 +/- 375 U/L, PO2/FiO2 285 +/- 63, CRT < 2 s, and the adrenalin dosage 0.08 +/- 0.04 microg/(kg.min) and dopamine 8.53 +/- 6.72 microg/(kg.min), urine output 2.9 +/- 1.6 ml/(kg.hr) after 24 hour treatment with CVVH. Of the 9 children, 2 died of MODS (1 intussusception complicated with intestine necrosis, 1 severe scald) and 1 was given up because of severe intestinal fistula, the other 6 children recovered at the end.
Conclusion:
CBP was effective in treatment of pediatric septic shock by improving the oxygenation, correcting metabolic acidosis, stabilizing BP, increasing the tissue perfusion and eliminating the medium molecule substances.
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