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Yaroustovsky et al. Blood purification in intensive care patients

Table 1: Changes of clinical and laboratory data before and after LPS-adsorptionin the children with sepsis
Indices Before After P
MAP, mmHg 65.5 (63.5-74.8) 80.5 (76.3-83.5) 0.012
HR, beats/min 141 (126-146) 135 (126-141) 0.19
Epinephrine, μg/kg/min 0.05 (0.048-0.07) 0.05 (0.05-0.06) 0.92
Body temperature, °C 37.9 (36.2-38.5) 36.8 (36.6-37.1) 0.07
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WBC, 10 /L 13.3 (9.2-20.1) 11.5 (9.4-20.4) 0.65
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PLT, 10 /L 164 (81-257) 132 (67-253) 0.5
PCT, ng/mL 5.11 (2.48-19.48) 1.24 (0.76-2.14) 0.11
EAA 0.75 (0.68-0.97) 0.6 (0.33-0.8) 0.013
Presepsin, pg/mL 914 (673-2,812) 525 (288-3,343) 0.44
CRP, mg/dL 3.41 (1.37-5.95) 1.5 (1.04-3.67) 1.0
LPS: lipopolysaccharide; MAP: mean arterial pressure; HR: heart rate; WBC: white blood cell; CRP: C-reactive protein; PLT: platelet; PCT:
procalcitonin; EAA: endotoxin activity assay
experience with selective LPS-adsorption for sepsis The results are expressed as the median and
treatment in children after congenital heart disease interquartile range. The critical level of significance
correction with cardiopulmonary bypass. Selective was set at 0.05. Nine patients were discharged, and
endotoxin adsorption was carried out using Polymyxin one patient died of cerebral edema and MODS after
B-immobilized cartridges (Toraymyxin-PMX-0.5R). repeated emergency surgery due to the development
Ten children aged 9-48 months and weighing 6.2-14 kg of an acute fistula of the prosthetic mitral valve.
received this procedure. In 8 cases, the infection
source was ventilator-associated pneumonia, and in Other authors also reported that this blood purification
1 case, it was mediastinitis and pleural empyema, and method in children has no side effects. [75,76] Our results
in 1 patient infected by bacterial translocation from the suggest that selective LPS-adsorption in children
gut after the ECMO procedures (duration of 5 days) from middle childhood is clinically effective and safe.
and dysfunction of gut. Gram-negative etiology in all Endotoxin adsorption using Polymyxin B cartridges is
cases was confirmed by microbiological examination one of the promising methods in children.
of blood and of bronchoalveolar lavage fluid (sputum).
The decision to include selective LPS-adsorption in In this article, we briefly discussed some aspects
complex therapy was made on the basis of clinical and of blood purification in the ICU of a cardiac surgery
laboratory data by a council of physicians. This study hospital. Over the last several decades, there have
was approved by the Local Ethics Committee of the been huge changes in extracorporeal therapy use for
A.N. Bakulev NSPCCS. critically ill patients. This is due to the proven efficiency
of these methods in many pathological conditions
Children before LPS-adsorption have clinical and and the emergence of new promising technologies.
laboratory signs of sepsis, hyperthermia (38.7- The availability of appropriate equipment and trained
39.5 °C), leukocytosis/leucopenia 3.3-21 × 10 /L, medical staff limiting the wide use of extracorporeal
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subcompensated disseminated intravascular blood purification, especially in pediatric intensive care
coagulation syndrome (D-dimer 530-1,580 ng/mL), where it seems so complicated, is a thing of the past.
procalcitonin 6.5-130 ng/mL, presepsin 415-1,300 The only issue that preserves a degree of technical
pg/mL, EAA 0.6-1.0, and high levels of CRP. The complexity is creating adequate vascular access in a
cardiopulmonary component prevails in the structure child and providing the possibility of performing the full-
of organ failure, which requires multicomponent dose extracorporeal therapy according to the protocol
inotropic and/or vasopressor support and mechanical and the assigned clinical tasks. Of course, we await
ventilation with high positive end expiratory pressure. the results of new multicenter randomized trials and its
Two children required RRT, daily intermittent application for practical goals of blood purification in
hemodialysis, which used polysulphone high-flux specific pathological conditions and clinical situations,
membrane filters (AVpaed, Fresenius, Germany). particularly in MODS. These results will allow the most
appropriate time for the initiation of blood purification
The results of this pilot study showed an improvement to be determined, valid indications to be developed
in hemodynamic and oxygenation indices, a tendency and its efficiency to be proven (convective or diffusive,
for leukocytosis and body temperature to decrease, continuous or intermittent, sorption or apheresis) in
positive X-ray dynamics and negative microbiological critically ill patients after high-risk surgery.
examination results. After LPS-adsorption, we noted
decreases in the endotoxin level, procalcitonin and Authors’ contributions
CRP [Table 1]. Statistical analyses were performed Conception, design and methodology of the study,
with SPSS software, version 20 (SPSS, Inc., USA). results analysing and manuscript writing: M.
Vessel Plus ¦ Volume 1 ¦ June 27, 2017 57