Hemoadsorption with CytoSorb - Pediatric Case
This paper has not yet been published but will most likely be appearing as another 'case of the week'.
Hemoadsorption with Adult CytoSorb® in a Low Weight Pediatric
Case - A Worldwide Premiere Procedure
Authors:
Catalin Gabriel Cirstoveanu1,2
Ileana Barascu2
Samantha Mc Kenzie Stancu1
Affiliations:
“Carol Davila” University of Medicine & Pharmacy, Bucharest
37 Dionisie Lupu Street, District 1, Bucharest, Romania 020021
“Marie S. Curie Children’s Emergency Hospital” Bucharest 2
Neonatal Intensive Care Unit
20 Constantin Brancoveanu Street, District 4, Bucharest, Romania
041451
ABSTRACT
Cytokine adsorber (CytoSorb®) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis, septic shock and to reduce blood myoglobin, unconjugated bilirubin and conjugated bilirubin. In this article we present the case of a nine-month male infant who was admitted to the NICU due to sepsis post cardiac surgery - Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure, renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemoadsorption with CytoSorb®. HDF was safe and effective from the first day for urea removal, but the patient’s bilirubin levels kept increasing gradually, culminating on the 9th day with a maximum value of 54 mg/dl of total bilirubin and 31.67 mg/dl of direct bilirubin when we performed hemoadsorption with CytoSorb®. Over the 49-hours period of hemoadsorption, the total bilirubin value decreased from 54 to 14 mg/dl, the patient’s general status improved considerably accompanied by a rapid drop of
aminotransferases. Hemodynamic status has been improved as well and inotropes dropped rapidly. The patient’s ventilation settings improved during CytoSorb® treatment permitting to wean the patient from mechanical ventilation after five days of hemoadsorption. The patient was discharged home after 34 days of hospitalization, in a good general status.
