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Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Exploratory dose modeling of hemoadsorption in pediatric septic shock
1Pediatric Intensive Care Unit, Children Hospital Bambino Gesù, IRCCS, Largo Sant'Onofrio 4, Rome, 00162, Italy. gabriella.bottari@opbg.net.
Intensive Care Medicine Experimental
|June 22, 2026
Summary
Pediatric septic shock hemoadsorption (HA) showed high blood purification but cytokine reduction depended on initial levels, not just HA dose. This suggests inflammatory burden, not just exposure, drives treatment efficacy.
Area of Science:
- Pediatric Critical Care Medicine
- Biomedical Engineering
- Pharmacokinetics
Background:
- Clinical outcomes of hemoadsorption (HA) in sepsis are unclear.
- Knowledge gaps exist in patient selection and device application, particularly regarding dosing.
- Pediatric studies suggest more favorable outcomes than adult cohorts.
Purpose of the Study:
- Investigate the concept of dose in pediatric septic shock.
- Elucidate mechanistic determinants of hemoadsorption treatment efficacy.
- Explore the relationship between blood purification dose and cytokine reduction.
Main Methods:
- Retrospective analysis of 25 children with septic shock treated with CytoSorb® and continuous renal replacement therapy (CRRT).
- Hemoadsorption dose expressed as Amount of Blood Purified (ABP, L/kg).
- Kinetic simulations and multivariable linear regression to assess cytokine reduction (IL-6) in relation to ABP and baseline concentration.
Main Results:
- Median ABP was 14.4 L/kg, exceeding adult thresholds.
- No linear association between ABP and vasopressor reduction.
- IL-6 reduction strongly correlated with baseline IL-6 concentration (R² = 0.79), not independently predicted by ABP.
Conclusions:
- Hemoadsorption in pediatric septic shock is associated with high ABP and significant cytokine reduction.
- Mediator removal may be concentration-driven rather than dose-limited beyond a certain exposure.
- Further investigation into dosing strategies based on inflammatory burden is warranted.
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