Extracorporeal Blood Purification in European Pediatric Intensive Care Units: A Consensus Statement

Area of Science:

• Pediatric Critical Care Medicine
• Extracorporeal Therapies
• Biomaterials Science

Background:

• Advances in extracorporeal blood purification therapies (EBPTs) are hindered by a lack of established clinical guidelines, resulting in significant practice variability.
• Pediatric intensive care units (PICUs) face unique challenges with EBPTs due to small patient numbers, diverse diagnoses, and technical difficulties, increasing the risk of adverse events.

Purpose of the Study:

• To gather insights from experienced EBPT users on critical issues.
• To inform the design of future research studies.
• To guide the application of EBPTs in pediatric patient care.

Main Methods:

• A literature search was conducted across PubMed and Embase (Jan 2020 - Jul 2024).
• A modified Delphi-based model was used to develop a consensus statement among 15 expert panelists (authors and pediatric intensivists) between 2022 and 2024.
• A questionnaire on EBPT use in PICUs, including indications, discontinuation criteria, and outcome assessment, was distributed and analyzed using SurveyMonkey.

Main Results:

• 116 survey responses were collected from panelists across 8 European countries.
• Strong consensus (>90% agreement) was achieved on 6 of 24 questions, with consensus (75%-90% agreement) on 18 questions.
• Continuous renal replacement therapy (CRRT) hemofilters and plasma exchange were identified as the most applied EBPTs, though evidence for hemoadsorption remains limited.

Conclusions:

• This consensus statement provides expert guidance on EBPTs for critically ill pediatric patients, particularly where clinical evidence is scarce.
• The findings aim to support pediatric intensivists in making informed bedside decisions.
• The consensus can guide future research priorities for EBPTs in PICUs.