Frische Studie aus dem American Journal of Pediatrics.
Die nachfolgende Quelle beschreibt den Adsorber-Einsatz bei zehn pädiatrischen – sogar neonatalen – Patienten in Italien, die alle die maximale Standardtherapie bekommen hatten, ohne darauf noch anzusprechen. Wir haben es hier mit einer retrospektiven Single Center Studie zu tun, die kein abschließendes Urteil erlaubt aber durchaus weitere Indizien liefert.
„Abstract: We describe the use of CytoSorb in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in ten severely ill pediatric patients with multiple organ failures of various etiologies; Measurements: The aim was to assess the effects on the inflammatory status, hemodynamics, and clinically relevant outcome parameters as well as the feasibility and safety of CytoSorb application in pediatrics; Main Results: We observed a marked decrease in inflammatory mediators, a reduction in catecholamine dosages and an improvement in organ functions, which was particularly pronounced in patients who survived. An early onset of treatment (at best within 24-48 hours after diagnosis of sepsis) seemed to be beneficial for eventual survival.
Conclusions: The present case series is the first documentation of a set of pediatric/neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in
organ functions as well as safety and feasibility. Further prospective randomized controlled studies in the pediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.“
Zum Zeitpunkt des Adsorber-Einsatzen litten alle Patienten bereits an einem multiplen Organversagen und haben in keiner Weise noch auf die Standardtherapien angesprochen: „In brief, all patients had multiple organ failure of various
etiologies including septic shock and cardiac failure (Table 1) and were refractory to conventional therapeutic treatment.“
Alle Patienten mussten bereits beatmet werden, wobei das Patientengut grundsätzlich sehr heterogen war, wie die nachfolgende Tabelle zeigt:
„Patient characteristics and diagnoses were rather heterogeneous (Table 1). Patient age ranged from 1-312 months (median 33) and patient weight in the study group was
between 3.5 – 52 kg (median weight 19 kg), 7 patients were female, 3 were male. All pediatric patients showed a clinical condition characterized by the presence of a dysregulated systemic inflammatory response and uncontrolled release of
inflammatory mediators (Figure 1 and 2) and all were in an advanced state of refractory septic shock or cardiac failure with a dysfunction of two or more organs (including CRRTdependent renal failure), DIC and severe cardio-circulatory and metabolic dysfunctions (Table 1).“
ALLE Patienten, die erst 48 Stunden nach der Sepsis-Diagnose eine Cytosorb-Therapie bekamen, starben. ALLE Patienten, die innerhalb der ersten 24 Stunden nach der Sepsis-Diagnose eine Cytosorb-Therapie bekamen, haben überlebt.
„All patients who started their hemoadsorption treatment within 24 hours after diagnosis
(n=3) survived as did two patients treated between 24-48 hours after diagnosis of sepsis (Table 1).“
Anzumerken ist, dass man hier halbe Klimmzüge macht, Patienten, die teilweise unter 10 kg Körpergewicht haben, an den Erwachsenen-Adsorber (300 ml) überhaupt anklemmen zu können. Die Forderung nach einem kleineren Adsorber für die Pädiatrie wird lauter. Das Priming erfolgt hier auch nicht mit Kochsalzlösung, sondern mit Blut/Plasma.
Meine Laien-Sicht: sobald der Vasopressorenbedarf steigt, nicht lange zögern und warten, bis alles Matsch ist. Spätestens mit der Sepsis-Diagnose, so scheint es, sollte man schleunigst den Adsorber anklemmen.
Fazit: starker Tobak.
Quelle:
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