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Hemoadsorption for severe MIS-C in critically ill children, should we consider it as a therapeutic opportunity?
Bottari, Gabriella; Severini, Flavia; Markowich, Anna Hermine; Lorenzetti, Giulia; Ruiz Rodriguez, Juan Carlos; Ferrer, Ricard; Francalanci, Paola; Ammirati, Antonio; Palma, Paolo; Cecchetti, Corrado.
  • Bottari G; Pediatric Intensive Care Unit, Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Severini F; Department of Pediatrics, University of Rome Tor Vergata, Residency School of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Markowich AH; Department of Pediatrics, University of Rome Tor Vergata, Residency School of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Lorenzetti G; Department of Pediatrics, University of Rome Tor Vergata, Residency School of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Ruiz Rodriguez JC; Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
  • Ferrer R; Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research, Institute (VHIR), Barcelona, Spain.
  • Francalanci P; Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
  • Ammirati A; Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research, Institute (VHIR), Barcelona, Spain.
  • Palma P; Unit of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Cecchetti C; Pediatric Emergency Unit, Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy.
Int J Artif Organs ; 45(10): 871-877, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1927988
ABSTRACT
Multisystem inflammatory syndrome (MIS-C) is a new severe clinical condition that has emerged during the COVID-19 pandemic. MIS-C affects children and the young usually after a mild or asymptomatic COVID-19 infection. MIS-C has a high tropism for the cardiovascular system with need for inotropes and vasopressor support in 62% of cases. As of today a mortality from 1.5% to 1.9% related to MIS-C is reported. Hemoadsorption via the inflammatory mediator adsorber CytoSorb (CytoSorbents Europe, Berlin Germany) has been used as adjunctive therapy with the aim to restore the host response in septic shock and other hyper-inflammatory syndromes. We present the clinical experience of an adolescent boy with a refractory shock secondary to left ventricular dysfunction (LVD) in the context of MIS-C, treated with hemoadsorption, and continuous kidney replacement therapy (CKRT) in combination with immunomodulatory therapies. The therapeutic strategy resulted in hemodynamic and clinical stabilization as well as control of the hyperinflammatory response. Treatment appeared to be safe and feasible. Our findings are in line with previously published clinical cases on Cytosorb use in MIS-C showing the beneficial role of the hemoperfusion with Cytosorb in severe MIS-C to manage the cytokine storm. We provide an analysis and comparison of recent evidence on the use of hemoadsorption as an adjuvant therapy in critically ill children with severe forms of MIS-C, suggesting this blood purification strategy could be a therapeutic opportunity in severe LVD due to MIS-C, sparing the need for extracorporeal membrane oxygentation (ECMO) and other mechanical cardiocirculatory supports.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / COVID-19 Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Humans / Male Language: English Journal: Int J Artif Organs Year: 2022 Document Type: Article Affiliation country: 03913988221111179

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / COVID-19 Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Humans / Male Language: English Journal: Int J Artif Organs Year: 2022 Document Type: Article Affiliation country: 03913988221111179