Extracorporeal hemocorrection in complex therapy of septic shock in children

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OBJECTIVE

To assess an effectiveness of extracorporeal hemocorrection (EH) in therapy of septic shock in children.

MATERIAL AND METHODS

A multiple-center observational uncontrolled study included 62 children aged 5 (2-13) years. Depending on timing and technique of EH, all patients were divided into 3 groups: group I — EH only for signs of acute kidney injury (AKI); group II — EH before AKI or for renal damage grade 1. In both these groups, only continuous veno-venous hemodiafiltration (CVVHDF) was used. In group III, EH was started immediately after diagnosis of septic shock, CVVHDF was combined with polymyxin B hemoperfusion. Cardiac index (CI), endotoxin activity assay (EAA), neutrophil phagocytic activity, vasoactive Inotrope Score (VIS), duration of mechanical ventilation and incidence of acute kidney injury were evaluated to assess effectiveness of therapy.

RESULTS

Significant decrease of VIS compared to baseline value was noted in groups II (by 18.75%) and III (by 43.74%). In group III, we found significant increase of CI (from 3.1 to 4.0L/min/m²; p<0.05). In the same group, EAA reduction from 0.69 to 0.52 was detected a day after surgery (p<0.01). Moreover, we observed increase of phagocytic activity of neutrophils (from 0.56 to 0.6; p<0.05). Among survivors in all groups, restoration of kidney function was observed in 89.9% of cases. Incidence of terminal AKI followed by hemodialysis was 11.1%. In-hospital mortality was minimal in the third group.

CONCLUSION

Early EH (CVVHDF combined with polymyxin B hemoperfusion) reduces ICU stay and improves the outcomes in children with septic shock.

Keywords:

generalized fulminant meningococcal infection

sepsis

septic shock

extracorporeal hemocorrection

polymyxin B hemoperfusion (PMX hemoperfusion)

children

outcome

Authors:

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0002-2131-4813

Serednyakov K.V.

Children’s Research and Clinical Center for Infectious Diseases of the FMBA of Russia;
St. Petersburg State Pediatric Medical University

Pshenisnov K.V.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0003-1113-5296

Received:

11.01.2021

Accepted:

23.04.2021

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