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Case Reports in Critical Care
Volume 2017, Article ID 6987167, 5 pages
https://doi.org/10.1155/2017/6987167
Case Report

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

1“Carol Davila” University of Medicine & Pharmacy Bucharest, 37 Dionisie Lupu Street, District 1, 020021 Bucharest, Romania
2“Marie S. Curie Children’s Emergency Hospital” Bucharest, Neonatal Intensive Care Unit, 20 Constantin Brancoveanu Street, District 4, 041451 Bucharest, Romania

Correspondence should be addressed to Catalin Gabriel Cirstoveanu; moc.oohay@unaevotsric

Received 9 October 2016; Accepted 28 November 2016; Published 3 January 2017

Academic Editor: Zsolt Molnár

Copyright © 2017 Catalin Gabriel Cirstoveanu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cytokine adsorber (CytoSorb) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis and septic shock and to reduce blood myoglobin, unconjugated bilirubin, and conjugated bilirubin. In this article we present the case of a nine-month-old male infant who was admitted to the NICU due to sepsis after cardiac surgery, Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure and renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemadsorption with CytoSorb. HDF was safe and effective from the first day for urea removal, but the patient’s bilirubin levels kept increasing gradually, culminating on the 9th day with a maximum value of 54 mg/dL of total bilirubin and 31.67 mg/dL of direct bilirubin when we performed hemadsorption with CytoSorb. Over the 49-hour period of hemadsorption, the total bilirubin value decreased from 54 to 14 mg/dL, and the patient’s general status improved considerably accompanied by a rapid drop of aminotransferases. Hemodynamic status has been improved as well and inotropes dropped rapidly. The patient’s ventilation settings improved during CytoSorb treatment permitting weaning the patient from mechanical ventilation after five days of hemadsorption. The patient was discharged home after 34 days of hospitalization, in a good general status.