Replies to post #7766 on CytoSorbents Corporation (CTSO)

[techxen]

Pediatric septic shock

I could not find this as one of the weekly case studies that have been published this year. Since January, the company has published 46 case studies. The last pediatric case that the company formally presented was back in November of 2015 during the Q3 earnings call. It was a 4 year old girl who had developed toxic shock syndrome after an insect bite. She had extensive capillary leak syndrome, was progressing towards scalded skin syndrome, which is akin to having a massive burn injury all over the body. She made a complete recovery after three weeks and CytoSorb was credited with helping to save for the life and helping to prevent an amputation for leg. The case was later presented at the Hungarian Pediatric Congress.

The use of Cytosorb in treating pediatric patients is an area I would think the company definitely has an interest in and is studying as some of the board members and officers have a background in this area. Dr. Paul Checchia, who is on the company's Cardiac Surgery Board, is the Medical Director of the Pediatric Cardiovascular ICU at Texas Children's Hospital in Houston.  He is also Professor of Pediatric Critical Care Medicine and Pediatric Cardiology at Baylor College of Medicine.  Also Gregory Di Russo whom the company hired as Senior VP of Clinical Development, is an accomplished pediatric cardiothoracic surgeon specializing in congenital cardiac surgery, and was Vice Chairman of Cardiothoracic Surgery at the Children's National Medical Center in Washington, D.C.

[andy55q]

Hybrid blood purification strategy in pediatric septic shock Gabriella Bottari1* , Fabio Silvio Taccone2 and Andrea Moscatelli1
Extracorporeal blood purification techniques (EBTs) are emerging as beneficial interventions in the management of sepsis. Although the combination of different EBTs has also been suggested as a potentially effective approach in the early phases of sepsis [1, 2], no data are available for pediatric septic shock. We reported a case of refractory septic shock in a 12-year-old girl, with a clinical history of acute lymphatic leukemia and recent chemotherapy, who was admitted to the emergency department (ED) because of fever and fatigue. In the ED ward, mean arterial pressure (MAP) was below 50 mmHg and did not improve after initial fluid resuscitation (20 ml/kg). Empiric antimicrobial therapy was initiated and the patient was admitted to the pediatric intensive care unit. Because of severe persistent hypotension with arterial lactate concentrations of 74 mg/dl, epinephrine and norepinephrine were initiated at 0.2 µg/kg/min and 0.08 µg/kg/min, respectively. Six hours after admission, the patient remained severely hypotensive (MAP of 45 mmHg) despite fluid and vasopressor therapy and low-dose hydrocortisone administration. In the absence of oliguria, continuous renal replacement therapy (CRRT) was started (continuous venovenous hemodiafiltration modality; effluent of 35–40 ml/kg.h)
with a high cutoff (HCO) filter (Septex®) in combination with a cartridge column (CC; Cytosorb®). A significant reduction of vasopressor doses was observed 48 hours after the initiation of EBT (Fig. 1). A similar positive trend was observed for lactate (74 vs 32 mg/dl) and procalcitonin (65 vs 18 ng/ml) concentrations. This “hybrid” EBT was continued for 72 hours without adverse events. The patient was successfully discharged after 10 days. The blood cultures yielded Klebsiella pneumonia, related to a percutaneously inserted central line infection. In this case, the benefits of CRRT in the management of fluid overload and metabolic abnormalities in children with septic shock were associated with the immune-modulatory effects of EBTs. HCO filters are characterized by large pore size (e.g., cutoff value of 70 kDa) with improved convective clearance of middle molecular weight molecules, such as cytokines [3]. CCs have a large surface area that could also directly adsorb and clear inflammatory mediators [4]. The combination of HCO-CRRT and CC might have a synergistic effect in this setting [5]; this association has not yet been explored in the treatment of pediatric septic shock. Further studies are needed to assess the feasibility as well as the optimal timing of initiation of such an approach in children suffering from septic shock.