Inhaled dry salt micro particles in the treatment of bronchopulmonary dysplasia: a five case series report

Background. Despite current medical advances, to this day there is no single medical intervention to effectively prevent or treat bronchopulmonary dysplasia (BPD) in both preterm and term infants. Along with protective ventilation strategies, various drugs are being used or are being researched at this very moment, with the sole purpose of improving the general outcome for these patients. Inhaled dry salt micro particles therapy is now one of them. Materials and methods. This report presents five patients, diagnosed with severe BPD. All of them received, complementary to classical BPD management and respiratory support, continuous inhaled dry salt micro particles, via SaltMed cartridges, for a period of 12 to 30 days. After only 24 hours of administration, we were able to observe a significant improvement in respiratory function and dynamics. It was possible to use a lower fraction of inspired oxygen (FiO2), mean airway pressure (MAP) and peak inspiratory pressure (PIP) in all mechanically ventilated patients. Higher tidal volumes were recorded and we observed improvement in oxygenation indexes. Conclusion. Continuously inhaled dry salt micro particles, administered complementary to classic BPD management, could improve respiratory and overall morbidity and mortality in infants with any form of BPD. Further study of these possible effects is needed, as there is no data published on this matter so far

Hemadsorption with Adult CytoSorb® in a Low Weight Pediatric Case

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