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The Sublingual Microcirculation in Critically Ill Children with Septic Shock Undergoing Hemoadsorption: A Pilot Study
Gabriella Bottari1, Valerio Confalone1, Jacques Creteur2
1Pediatric Intensive Care Unit, Bambino Gesuù Children's Hospital, Scientific Institute for Research, Hospitalization, Healthcare (IRCCS), 00165 Rome, Italy.
Biomedicines
|July 27, 2024
Summary
This pilot study suggests hemoadsorption with CytoSorb may improve microcirculation in pediatric septic shock patients. Improvements in microvascular flow index and perfused vessel proportion were observed during treatment.
Area of Science:
- Pediatric critical care medicine
- Intensive care
- Septic shock management
Background:
- Perfusion-guided resuscitation is increasingly important in septic shock.
- The role of hemoadsorption in addressing microvascular alterations in this setting is under investigation.
Purpose of the Study:
- To explore the potential beneficial role of hemoadsorption in microvascular alterations in pediatric septic shock.
- To analyze the impact of continuous renal replacement therapy (CRRT) combined with CytoSorb on sublingual microcirculation.
Main Methods:
- Secondary analysis of a Phase-II, single-arm pilot study (NCT05658588).
- 17 pediatric septic shock patients treated with CRRT and CytoSorb.
- Sublingual microcirculation assessed at baseline and 24, 48, 72, 96 hours using microvascular flow index (MFI) and proportion of perfused vessels (PPV).
Main Results:
- Significant improvement in MFIs (p=0.01) and PPVs% (p=0.04) from baseline to 24 hours post-treatment in 10/13 patients.
- Seven patients showed improved microcirculation, with 5/8 patients with high heterogeneity index (HI > 0.5) improving (HI < 0.5) by study end.
- Responders defined by MFI ≥ 2.5 and/or PPV > 90% by 96 hours.
Conclusions:
- CytoSorb hemoadsorption shows a potential association with improved microcirculation in pediatric septic shock.
- This microcirculatory improvement may be linked to hemodynamic enhancement.
- Further research is warranted to confirm these findings in larger trials.
