Efficacy of direct hemoperfusion using polymyxin B-immobilized fiber in children

Abstract

Performing direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) for low-body-weight children is not common. Because acute blood purification is technically difficult to perform and there are no appropriate tools for these children. We report our experience of PMX-DHP in children under 10kg with unstable circulatory dynamics and the efficacy of PMX-DHP in these children. We performed PMX-DHP nine children (age, 0 days-7 months; body weight, 1.2 to 6.6 kg) diagnosed septic shock. We evaluated the following parameters before and after treatment: mean arterial pressure (MAP), catecholamine index (CAI), ratio of the arterial partial pressure of oxygen to the fraction of inspired oxygen (P/F ratio), serum creatinine, urine volume, pediatric logistic organ dysfunction (PELOD) score, and predicted mortality rate. There were some complications, namely, hypothermia, intracircuit clot formation, and decrease in platelet count. No PMX-related deaths occurred. MAP values elevated from 34.9±12.2 mmHg to 47.4±8.5 mmHg within 2h. The PELOD score and predicted mortality rate significantly decreased from 43.2±10.9 to 24.8±6.1 and from 90.4%±22.9% to 37.7%±22.2%, respectively. The prognosis at 28 days was as follows: alive, 6 patients and dead, 3 patients. PMX was safely performed in low-body-weight children. PMX could elevate their body pressure and improve their prognosis. PMX-DHP might help in elevating the survival rate of low-blood-weight children with poor prognosis.