Acute Crit Care.  2019 Nov;34(4):284-288. 10.4266/acc.2017.00528.

A successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with septic shock

• Kim YA
• Kim H
• Kim YM
• Park SE

• KMID: 2467309
• DOI: http://doi.org/10.4266/acc.2017.00528

Abstract

Direct hemoperfusion therapy with a polymyxin B-immobilized fiber column (PMX-HP) has been introduced as a therapeutic option for gram negative bacterial septic shock in adults. However, its use in neonates and children has not yet been established. We successfully performed hemoperfusion therapy using an adult polymyxin B-immobilized fiber column in a neonate with carbapenem resistant Acinetobacter baumannii septic shock. The application was technically feasible because the neonate was on extracorporeal membrane oxygenation (ECMO). Although it did not rescue the patient, there was significant short-lasting improvement in pulmonary oxygenation and hemodynamics, leading to wean the patient from ECMO. PMX-HP could be used as an adjunctive treatment for selected neonatal and pediatric patients with gram negative bacterial septic shock.

Keyword

extracorporeal membrane oxygenation; hemoperfusion; neonate; polymyxin B

MeSH Terms

Acinetobacter baumannii
Adult*
Child
Extracorporeal Membrane Oxygenation
Hemodynamics
Hemoperfusion*
Humans
Infant, Newborn*
Oxygen
Polymyxin B
Polymyxins*
Shock, Septic*
Oxygen
Polymyxin B
Polymyxins

Figure

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  Figure 1. Clinical course and serial changes of PaO2/FiO2 ratio and inotropic score. ECMO was applied to a 7-day-old neonate with septic shock. After the application of PMX-HP, PaO2/FiO2 ratio was improved and inotropic score decreased, and the ECMO was discontinued. However, the patient’s condition deteriorated and the patient died on the 20th day of life. ECMO: extracorporeal membrane oxygenation; PMX-HP: hemoperfusion therapy with a polymyxin B-immobilized fiber column.

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  Figure 2. Pictures of devices. (A) An adult polymyxin B-immobilized fiber column (gray arrow) with a circuit and a hemofiltration set (white arrow) were placed on each device. (B) The access lines of the polymyxin B direct hemoperfusion device and continuous renal replacement therapy were simultaneously connected to the proximal drainage line of the extracorporeal membrane oxygenation circuit, their return lines were connected to the distal drainage line.

Reference

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