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Published on: May 26, 2023
Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery
Michail Yaroustovsky1, Marina Abramyan2, Ekaterina Rogalskaya2
1Federal State Budget Institution "A.N. Bakulev National Medical Research Centre for Cardiovascular Surgery" of the Ministry of Healthcare of the Russian Federation (Bakulev NMRCCS), Moscow, Russian Federation, mbyar@yandex.ru.
Insights
Polymyxin B hemoperfusion improved sepsis treatment in children after heart surgery, increasing survival rates. This therapy demonstrated safety and effectiveness in critically ill pediatric patients.
Area of Science:
- Pediatric Intensive Care
- Cardiovascular Surgery
- Infectious Diseases
Background:
- Sepsis is a major challenge in pediatric intensive care, particularly for newborns and children with chronic conditions.
- Pediatric cardiac surgery patients face a 15-30% incidence of infectious complications, with endotoxin as a primary sepsis factor.
Purpose of the Study:
- To evaluate the efficacy and safety of polymyxin B-immobilized column-direct hemoperfusion for sepsis in children post-cardiac surgery.
- To assess the impact of endotoxin elimination on patient outcomes.
Main Methods:
- Prospective cohort study of 15 children (9-96 months) with congenital heart disease and sepsis.
- Treatment included intensive care, antibiotics, and two 180-minute hemoperfusion sessions using a polymyxin B column within 24 hours of sepsis diagnosis.
- Inclusion criteria: body weight >6 kg, clinical/lab signs of sepsis (PCT >2 ng/mL, EAA >0.6).
Main Results:
- Significant improvements observed in hemodynamic parameters, oxygenation index, and sepsis markers (EAA, PCT, presepsin).
- Endotoxin levels decreased, and 28-day survival rate was 80% in this high-risk group.
- Polymyxin B hemoperfusion was found to be safe and effective.
Conclusions:
- Extracorporeal blood purification targeting endotoxin enhances survival rates in children with sepsis after open-heart surgery.
- Polymyxin B hemoperfusion is a safe and effective therapeutic option for pediatric sepsis patients following cardiac surgery.
Background:
To date, sepsis remains one of the main challenges of intensive care in pediatrics. Newborns with low birth weight and infants with chronic diseases and congenital disorders are particularly at risk. The incidence of infectious complications in pediatric cardiac surgery is known to be approximately 15-30%. The main etiological factor of sepsis is endotoxin.
Aim:
To evaluate the efficiency and safety of polymyxin (PMX) B-immobilized column-direct hemoperfusion in complex intensive therapy of sepsis in children after cardiac surgery with cardiopulmonary bypass.
Design:
Prospective cohort study.
Methods:
This study enrolled 15 children, aged 9-96 months, with congenital heart diseases and with body weights of 6.2-22.5 kg. The criteria for admission were body weight >6 kg and clinical and laboratory signs of sepsis (microbiological analysis, procalcitonin [PCT] >2 ng/mL, and endotoxin activity assay [ЕАА] >0.6). Intensive care included inotropic and vasopressor support, mechanical ventilation, broad-spectrum antibiotic therapy, and PMX hemoperfusion procedures. Extracorporeal therapy was initiated within 24 h following the sepsis diagnosis. Every patient underwent 2 hemoperfusion sessions with the use of a PMX B-immobilized column; the session duration was 180 min.
Results:
We noted improvements in hemodynamic parameters, oxygenation index, and laboratory signs of sepsis, with decreases in the endotoxin concentration according to the EAA, PCT, and presepsin levels. The 28-day survival of the patients in this severely affected group was 80%. Main Conclusion: The inclusion of extracorporeal methods of blood purification, aimed at the selective elimination of circulating endotoxin, in the treatment of sepsis increases the survival rates of children after open heart surgery. Second Conclusion: The obtained results of sepsis therapy with PMX hemoperfusion in children after cardiac surgery enable us to suggest the sufficient safety and efficiency of the procedures in this category of severely affected patients.
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