Hemoperfusion with CytoSorb to Manage Multiorgan Dysfunction in the Spectrum of Hemophagocytic Lymphohistiocytosis Syndrome in Critically Ill Children

2021 ◽  
pp. 1-8
Author(s):  
Gabriella Bottari ◽  
Manuel Murciano ◽  
Pietro Merli ◽  
Claudia Bracaglia ◽  
Isabella Guzzo ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Pediatric Intensive Care ◽  
Interleukin 10 ◽  
Critically Ill Children ◽  
Logistic Organ Dysfunction ◽  
The Impact

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by a state of hyperinflammation. Blood purification techniques can blunt the inflammatory process with a rapidly relevant nonselective effect on the cytokine storm, thus potentially translating into survival benefit for these patients. In this cohort, we evaluated the impact of hemoadsorption with CytoSorb combined with continuous kidney replacement therapy used as adjunctive therapy in 6 critically ill children with multiple organ dysfunction due to HLH. In our series, we found a reduction in inflammatory biomarkers in patients with HLH secondary to infection. Ferritin, one of the most important bedside biomarkers of HLH, showed a reduction in most of the treated patients. The same results were found measuring interleukin-6 and interleukin-10. The same patients showed hemodynamic stabilization measured by the Vasopressor-Inotropic-Score, and reduction in the organ disease score measured with the Pediatric Logistic Organ Dysfunction score. In our cohort, mortality was less than expected based on the Pediatric Index of Mortality 3 score at pediatric intensive care unit admission. Our study shows that hemoperfusion could be a valuable therapeutic option in HLH: stronger scientific evidence is needed to confirm our preliminary experience.

scholarly journals Severe sepsis criteria, PELOD-2, and pSOFA as predictors of mortality in critically ill children with sepsis

2019 ◽  
Vol 59 (6) ◽  
pp. 318-24
Author(s):  
Anindita Wulandari ◽  
Pudjiastuti Pudjiastuti ◽  
Sri Martuti
Keyword(s):  
Severe Sepsis ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Logistic Organ Dysfunction ◽  
High Care ◽  
Life Threatening ◽  
Physical Examinations

Background Sepsis is one of the main causes of death in infants and children. Currently, it is defined as a life-threatening organ dysfunction, caused by an inflammatory response of infection. Several organ dysfunction assessment methods are available, but they are not uniformly used. Objective To compare the accuracy of three mortality predictor tools: severe sepsis criteria, pediatric logistic organ dysfunction (PELOD)-2, and pediatric sequential organ failure assessment (pSOFA), in critically ill children with sepsis. Methods This prospective cohort study was conducted in the pediatric intensive care unit (PICU) and pediatric high care unit (HCU) of dr. Moewardi Hospital, Surakarta, Central of Java. All patients who met the systemic inflammatory response syndrome (SIRS) criteria were included in our study. The exclusion criteria were congenital anomalies of heart or kidney, malignancy, or hematological abnormalities. The data were taken from laboratory and physical examinations by the physicians on duty. The outcome assessed was mortality. Results Of 30 subjects, the mean age was 22.22 (SD 29.36) months; the most common infection source was the respiratory tract, followed by gastrointestinal tract and central nervous system. Most subjects were treated in the PICU and had a mean length of stay of 8.70 (SD 11.91) days. Severe sepsis and PELOD-2 were not significant predictors of death. However, pSOFA score was a statistically significant predictor of mortality, with odds ratio 10.11 (95%CI 1.054 to 97.002; P=0.039). Conclusion Pediatric SOFA (pSOFA) is a better predictor of mortality compared to PELOD-2 and SIRS-severe sepsis. A pSOFA score ≥ 2 increases the risk of mortality by 10.11-fold.

scholarly journals Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 774
Author(s):  
Mara L. Leimanis-Laurens ◽  
Karen Ferguson ◽  
Emily Wolfrum ◽  
Brian Boville ◽  
Dominic Sanfilippo ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Intensive Care ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Lipid Profiles ◽  
Critically Ill Children ◽  
P Value ◽  
Time Points ◽  
Logistic Organ Dysfunction ◽  
Multi Organ Dysfunction Syndrome

Lipids are molecules involved in metabolism and inflammation. This study investigates the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n = 24) are analyzed at three time-points and cross-referenced to sedation controls (n = 4) for a total of N = 28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles are quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS), and compared to nutritional profiles and pediatric logistic organ dysfunction (PELOD) scores. Our results show that PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provides stratification between sedation controls and all MODS patients for total lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (ether-PE) (p-value = 0.03) after adjusting for sex and age. Nutrition intake over time did not correlate with changes in lipid profiles, as measured by caloric and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day pediatric intensive care unit (PICU) course, suggesting novel metabolic indicators for defining critically ill children.

scholarly journals MOBILIZAÇÃO PRECOCE EM CRIANÇAS CRITICAMENTE DOENTES: UMA REVISÃO INTEGRATIVA

2019 ◽  
Vol 8 (2) ◽  
pp. 1-13
Author(s):  
Susana Lígia Da Silva Rodrigues ◽  
Bárbara Carla De Araújo Rodrigues ◽  
Eliza Juliana Da Costa Eulálio ◽  
Renata Cavalcanti Farias ◽  
Andressa Bomfim Lugon Favero
Keyword(s):  
Critically Ill ◽  
Scientific Evidence ◽  
Adult Population ◽  
Pediatric Intensive Care ◽  
Early Mobilization ◽  
Bed Rest ◽  
Critically Ill Children ◽  
Critical Patients ◽  
Therapeutic Activities ◽  
Critical Ill

RESUMO A mobilização precoce vem se destacando na última década por ser uma estratégia alternativa para minimizar os efeitos deletérios do imobilismo no leito no paciente crítico. Consiste de atividades terapêuticas progressivas que se iniciam logo após a estabilização das alterações fisiológicas do paciente e oferece benefícios a curto, médio e longo prazo. Vários trabalhos evidenciam seus efeitos na população adulta, entretanto, pesquisas feitas com crianças são escassas. Objetivo: Verificar e reunir as evidências científicas disponíveis na literatura sobre mobilização precoce em crianças criticamente doentes. Metodologia: Trata-se de uma revisão sistemática de literatura do tipo integrativa, por meio da busca de artigos científicos nas bases de dados SciELO, BVS e PubMed, utilizando os descritores “children”, “critical ill”, “early mobilization”, “pediatrics” e “rehabilitation”, nos idiomas português e inglês, com textos completos publicados entre os anos de 2013 e 2018. Resultados: Foram encontrados 183 artigos elegíveis, dos quais 9 foram selecionados para serem revisados. Os trabalhos abordaram, principalmente, as barreiras, os benefícios, a segurança e a viabilidade da mobilização precoce nas Unidades de Terapia Intensiva Pediátricas (UTIPs), bem como o envolvimento do fisioterapeuta na reabilitação precoce da criança criticamente doente. Conclusões: A mobilização precoce é segura, viável, oferece poucos riscos ao paciente, favorece o aumento da mobilidade das crianças e pressupõe um menor tempo de internação. O fortalecimento da equipe multidisciplinar pode contribuir para a implementação da mobilização precoce em UTIPs. PALAVRAS-CHAVE: Criança; Doença Crítica; Mobilização Precoce; Reabilitação.EARLY MOBILIZATION IN CRITICALLY ILL CHILDREN: A INTEGRATIVE REVIEWABSTRACTEarly mobilization has been highlighted in the last decade as an alternative strategy to minimize the deleterious effects of bed rest in critical patients. It consists of progressive therapeutic activities that begin soon after stabilizing the physiological changes of the patient and offers benefits in the short, medium and long term. Several studies show its effects on the adult population, however, research on children is scarce. Objective: To verify and gather the scientific evidence available in the literature on early mobilization in critically ill children. Methodology: This is a systematic review of literature of the integrative type, through the search of scientific articles in the SciELO, BVS and PubMed, using the descriptors "children", "critical ill", "early mobilization", "pediatrics" and "rehabilitation", in Portuguese and English, with full texts published between 2013 and 2018. Results: 183 eligible articles, of which 9 were selected for review. The work focused on the barriers, benefits, safety and feasibility of early mobilization in Pediatric Intensive Care Units (PICUs), as well as the involvement of the physiotherapist in the early rehabilitation of critically ill children. Conclusions: Early mobilization is safe, viable, offers few risks to the patient, favors the increase of children’s mobility and presupposes a shorter hospitalization time. The strengthening of the multidisciplinary team can contribute to the implementation of early mobilization in PICUs.KEYWORDS: Child; Critical Illness; Early Mobilization; Rehabilitation.

scholarly journals Feasibility and Safety of Early Mobilization in Critically Ill Children: A Prospective Observational Study

2021 ◽  
Author(s):  
Damien Moerman ◽  
Grégory Reychler ◽  
Pauline Bednarek ◽  
Stéphan Clément de Cléty ◽  
Thierry Detaille ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Critically Ill ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Early Mobilization ◽  
Lower Limbs ◽  
Critically Ill Children ◽  
Secondary Outcome ◽  
Clinical Trial Registration ◽  
The Impact

Abstract The study aims to evaluate the feasibility and the safety of early mobilization in critically ill children under 2 years and its impact on comfort scores. This prospective, monocenter clinical trial was conducted in a tertiary care pediatric intensive care unit in Belgium. Twenty children were recruited to the study. Early mobilization was done between 24 and 48 hours of admission. Mobilization of upper and lower limbs was performed according to practice protocol. The heart rate (HR), respiratory rate (RR), systolic and diastolic blood pressures (SBP and DBP, respectively) and pulsed oxygen saturation were recorded before mobilization, immediately after the treatment and after 10, 30 and 60 minutes. The EDIN score for the extubated children and the COMFORT-B score for the intubated children were used in order to evaluate comfort. The primary outcome was the feasibility and safety of early mobilization. The secondary outcome was to evaluate the impact of early mobilization on comfort. Sixteen sessions were completed and 4 sessions of mobilization were interrupted because of important agitation. HR, SBP and DPB showed no change immediately after the mobilization, compared with baseline. RR and SpO2 were similar at the different times. Agitation had impact on the EDIN and COMFORT-B scores in children whose session was interrupted. No adverse events were reported.Conclusions: Early mobilization is feasible and safe in the majority of critically ill children under 2 years even if the agitation is described as an adverse event. Early mobilization does not influence the cardio-respiratory parameters.Clinical Trial Registration number and date of registration: Clinicaltrials.gov, NCT02958124, 10/09/2017

scholarly journals Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-abundance Plasma Phospholipids and Dynamic Recovery Over 8-Day Period, a Single-Center Observational Study

2020 ◽  
Author(s):  
Mara L. Leimanis Laurens ◽  
Karen Ferguson ◽  
Emily Wolfrum ◽  
Brian Boville ◽  
Dominic Sanfilippo ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Lipid Profiles ◽  
Critically Ill Children ◽  
P Value ◽  
Lipid Profiling ◽  
Time Points ◽  
Logistic Organ Dysfunction ◽  
Multi Organ Dysfunction Syndrome

AbstractLipids are stable molecules involved in metabolism and inflammation. We investigated the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n=24) were analyzed at three time points and cross referenced to sedation controls (n = 4) for a total of N=28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles were quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS) and compared to nutritional profiles and PEdiatric Logistic Organ Dysfunction (PELOD) scores. PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provided stratification between sedation controls and all MODS patients for lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (PE) (p-value = 0.03). Phospholipids in patients needing ECMO were observably closer to sedation controls than other MODS patients. Nutrition intake revealed changes in lipid profiles that corresponded to calorie and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day PICU course, suggesting novel indicators for defining critically ill children.

Comparison of the Automated Pediatric Logistic Organ Dysfunction-2 Versus Manual Pediatric Logistic Organ Dysfunction-2 Score for Critically Ill Children*

2020 ◽  
Vol 21 (4) ◽  
pp. e160-e169
Author(s):  
Michaël Sauthier ◽  
Florence Landry-Hould ◽  
Stéphane Leteurtre ◽  
Atsushi Kawaguchi ◽  
Guillaume Emeriaud ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Children ◽  
Logistic Organ Dysfunction
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