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Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series
Patcharin Saetang1, Rujipat Samransamruajkit1, Kanokwan Singjam2
1Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) showed promising results in improving pediatric septic shock severity scores and lactate levels. This adjunctive therapy was feasible and well-tolerated in a small case series, with a high survival rate.
Area of Science:
- Pediatric Critical Care Medicine
- Intensive Care Medicine
- Nephrology
Background:
- Septic shock in children is a life-threatening condition requiring intensive management.
- Polymyxin B-immobilized fiber direct hemoperfusion (PMX-DHP) is an extracorporeal treatment aimed at removing endotoxins.
- Its efficacy as adjunctive therapy in pediatric septic shock warrants further investigation.
Purpose of the Study:
- To evaluate the feasibility and preliminary efficacy of PMX-DHP as adjunctive therapy in pediatric patients with severe septic shock.
- To assess changes in clinical severity scores and biochemical markers following PMX-DHP treatment.
Main Methods:
- A prospective observational study was conducted in pediatric intensive care units.
- Six children (30 days to 15 years) with septic shock and high severity scores (PELOD-2 ≥ 10 or PRISM-3 ≥ 15) received 2-4 hour PMX-DHP treatments over two consecutive days.
- Clinical and laboratory data, including PELOD-2 scores, vasoactive inotropic score (VIS), and lactate levels, were monitored.
Main Results:
- All six enrolled patients had severe septic shock requiring mechanical ventilation and inotropes.
- Significant improvements were observed in PELOD-2 scores (14.3 to 6.0, p=0.006) and lactate concentrations (2.4 to 1.0 mmol/L, p=0.01) at 72 hours.
- VIS also decreased significantly (60 to 4.0 mmol/L, p=0.003).
- Five out of six patients survived, with no device-related adverse events.
Conclusions:
- PMX-DHP is a feasible adjunctive therapy for pediatric patients with refractory septic shock and high severity.
- The study suggests that clinical and severity of illness scores at 72 hours could serve as potential endpoints for future randomized controlled trials.
- PMX-DHP may offer a potential therapeutic option to improve outcomes in this critical patient population.
Objectives:
To evaluate the use of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) as adjunctive therapy during pediatric patients with septic shock.
Design:
Prospective observational study.
Setting:
Nine-bed PICUs at university referral hospital.
Patients:
Children (30 d to 15 yr) with septic shock and Pediatric Logistic Organ Dysfunction (PELOD)-2 score greater than or equal to 10 or Pediatric Risk of Mortality (PRISM) 3 score greater than or equal to 15, who were also receiving at least one inotrope.
Intervention:
Patients received 2-4 hour treatment with PMX-DHP 20R column on 2 consecutive days.
Measurements And Main Results:
We enrolled six children aged 21-167 months old (median, 99-mo old), with a body weight of 10-50 kg (median, 28 kg). All six patients had both PELOD-2 greater than or equal to 10 and PRISM-3 greater than or equal to 15, required invasive mechanical ventilation, and received standard treatment for septic shock before enrollment. We observed significant improvement in PELOD-2 score from baseline to 72 hours after the start of PMX-DHP (mean [95% CI] from 14.3 [12.2-16.5] to 6.0 [0.3-11.7]; p = 0.006). The vasoactive inotropic score (VIS) and lactate concentration also significantly decreased from baseline to 72 hours (VIS, 60 mmol/L [25-95 mmol/L] to 4.0 mmol/L [44.1-12 mmol/L]; p = 0.003; lactate, 2.4 mmol/L [1.0-3.8 mmol/L] to 1.0 mmol/L [0.5-1.5 mmol/L]; p = 0.01). Five of six patients survived. There was no device-related adverse event in these patients.
Conclusions:
In this case series of treatment with PMX-DHP as adjunctive therapy in children with refractory septic shock and high baseline severity, we have shown that patient recruitment is feasible. We have also found that clinical hemodynamic and severity of illness scores at 72 hours may be potential end points for testing in future randomized controlled trials.
