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Extracorporeal blood purification techniques in children with hyper-inflammatory syndromes: a clinical overview

Gabriella Bottari1, Matteo Di Nardo2, James Gleeson3,4

  • 1Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, Rome, Italy - gabriella.bottari@opbg.net.

Minerva Anestesiologica
|February 9, 2019
PubMed

Insights

Clinical data on blood purification for pediatric hyper-inflammatory syndromes (HS) is limited. Evidence is insufficient to confirm the efficacy and safety of these techniques in children, necessitating further research.

Area of Science:

  • Pediatric Critical Care
  • Nephrology
  • Extracorporeal Therapies

Background:

  • Clinical data on blood purification techniques in pediatric hyper-inflammatory syndromes (HS) is scarce.
  • Hyper-inflammatory syndromes can lead to severe organ dysfunction in children, prompting interest in extracorporeal support.

Purpose of the Study:

  • To provide a comprehensive clinical overview of blood purification in pediatric patients with hyper-inflammatory syndromes.
  • To assess the current evidence regarding the efficacy and safety of various blood purification modalities in this population.

Main Methods:

  • A comprehensive literature review was conducted using PubMed, EMBASE, Web of Science, and Scopus databases.
  • Searched for recent data on blood purification techniques in children up to June 2018.
  • Included randomized controlled trials, observational studies, and case reports.

Main Results:

  • Limited evidence exists, with only three randomized controlled trials (RCTs) on plasma exchange (PE) found.
  • High-volume hemofiltration showed no significant reduction in 28-day mortality in two non-randomized trials.
  • PE was not associated with reduced mortality in pediatric septic shock, though patient numbers were small; use of adsorbing columns is increasing but lacks robust data.

Conclusions:

  • The current evidence base for blood purification in pediatric hyper-inflammatory syndromes is of low quality.
  • No definitive conclusions can be drawn regarding the efficacy and safety of these techniques in children.
  • Further high-quality research is essential to guide clinical practice for extracorporeal blood purification in pediatric populations.

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