par Bottari, Gabriella
Président du jury Le Moine, Alain
Promoteur Taccone, Fabio Silvio
Publication Non publié, 2025-03-24
Thèse de doctorat
Résumé : Severe pediatric sepsis and septic shock remain leading causes of mortality and morbidity in critically ill children, despite advances in intensive care. Extracorporeal blood purification techniques, including hemoadsorption with CytoSorb, have emerged as potential adjuvant therapies to mitigate the dysregulated immune response characteristic of sepsis. This prospective pediatric pilot study investigates the impact of CytoSorb hemoadsorption on hemodynamic coherence and immune homeostasis in children with septic shock.The study enrolled pediatric patients requiring continuous kidney replacement therapy (CKRT) due to sepsis-associated acute kidney injury (S-AKI) and refractory septic shock. CytoSorb therapy was applied in combination with CKRT, and key hemodynamic parameters, inflammatory cytokine levels, and microcirculatory function were monitored. The results demonstrated significant reductions in pro-inflammatory cytokines (IL-6, IL-10, TNF-α) and improved hemodynamic stability, with a notable decrease in vasoactive-inotropic scores post-treatment. Sublingual microcirculation assessment indicated an enhancement in capillary perfusion, supporting the hypothesis that CytoSorb contributes to hemodynamic coherence.Despite promising findings, challenges remain regarding patient selection, optimal treatment timing, and safety in low-weight children. Further multicentric, randomized controlled trials are required to validate these preliminary results and refine clinical protocols. This study highlights the potential role of hemoadsorption in pediatric sepsis management, paving the way for personalized extracorporeal therapies to improve outcomes in critically ill children

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