The Sublingual microcirculation in critically ill children with septic shock undergoing hemoadsorption: a pilot study

BACKGROUND The importance of perfusion guided resuscitation in septic shock has recently emerged. We explored whether the use of hemoadsorption led to a potential beneficial role in microvascular alterations in this clinical setting. METHODS. Pre-planned secondary analysis of a Phase-II interventional single-arm pilot study (NCT05658588) where 17 consecutive septic shock children admitted into PICU were treated with continuous renal replacement therapy (CRRT) and CytoSorb. Thirteen patients were eligible to be investigated with sublingual microcirculation at baseline, 24, 48, 72 and 96 hours from the onset of blood purification. Patients achieving a microvascular flow index (MFI) ≥ 2.5 and/or proportion of perfused vessels (PPV) exceeding 90% by 96 hours were defined as responders . RESULTS. In 10/13 (77%) there was a significant improvement in MFIs (p = 0.01) and PPVs% (p = 0.04) between baseline and 24 hours from the end of treatment. Eight patients displayed a high heterogenicity index (HI > 0.5) during blood purification and among these, 5 showed an improvement by the end of treatment (HI < 0.5). CONCLUSIONS. Despite its limitations (absence of a control group), this pilot study suggests a potential beneficial effect of CytoSorb treatment on microcirculatory perfusion in septic shock patients, particularly when associated with hemodynamic improvement.