REVIEW   Free access

Minerva Anestesiologica 2019 May;85(5):531-42

DOI: 10.23736/S0375-9393.19.13189-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Extracorporeal blood purification techniques in children with hyper-inflammatory syndromes: a clinical overview

Gabriella BOTTARI ¹ ✉, Matteo DI NARDO ¹, James GLEESON ^{2, 3}, Francesca MINOIA ^{4, 5}, Andrea MOSCATELLI ⁶, Corrado CECCHETTI ¹, Enrico E. VERRINA ⁷

¹ Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, Rome, Italy; ² INSERM U1149, Inflammation Research Center, CNRS ERL8252, Inflamex Laboratory of Excellence, Faculty of Medicine Xavier Bichat, Paris, France; ³ Department of Nephrology, Royal College of Physicians of Ireland, Dublin, Ireland; ⁴ Unit of Pediatrics, De Marchi Clinic, Ca’ Granda Foundation and Institute for Research and Care, Maggiore Polyclinic Hospital, Milan, Italy; ⁵ Clinic of Pediatrics and Rheumatology, Giannina Gaslini Institute, Genoa, Italy; ⁶ Neonatal and Pediatric Intensive Care Unit, Giannina Gaslini Institute, Genoa, Italy; ⁷ Unit of Dialysis, Giannina Gaslini Institute, Genoa, Italy

Data on clinical applications of blood purification techniques in children are scarce. The aim of this review is to offer a clinical overview, as complete as possible, on blood purification in children with hyper-inflammatory syndromes (HS). A review of the literature using the PubMed, EMBASE, Web of Science, and Scopus databases, on the most recent data about blood purification in children was conducted until June 2018. Except for three randomized controlled trials (RCTs) on plasma exchange, no RCTs, but only observational studies or case reports were found regarding other blood purification techniques in children. High-volume hemofiltration in two non-randomized trials did not significantly reduce 28-day mortality in children. PE was not associated with reduced mortality in pediatric patients with septic shock, but the small number of patients enrolled is an important limitation. The use of polymixin B and other adsorbing columns in children with septic shock and HS is increasing, but results are still limited by the observational nature of the studies. Based on the low-level of available evidence, no conclusions can be drawn regarding the efficacy and safety of blood purification in children. Further research with more clinically robust data is needed to determine the impact of different extracorporeal blood purification techniques in this pediatric population.

KEY WORDS: Extracorporeal circulation; Child; Septic shock; Plasma exchange