Changes in microcirculation associated with using milrinone in children with sepsis shock

Objetivos: Evaluar los cambios en la microcirculación asociados al uso del milrinona en niños con sepsis. Se utilizó videomicroscopía sublingual para medir flujo y densidad capilar (DC) y región limite perfundida (PBR, parámetro inverso del grosor del glicocálix). El desenlace primario fue los cambios en la microcirculación asociados al uso de milrinona al ingreso y a las 24 horas. Diseño: Cohorte prospectiva realizado de Febrero 2021 – Enero 2022 Lugar: Unidad de cuidados intensivos pediátricos (UCIP) en hospital universitario. Pacientes: Niños con sepsis/choque séptico con y sin infusión de milrinona. Intervención: Ninguna Métodos y resultados principales: Se incluyeron 140 niños (mediana edad 2 años RIQ 0.58-12.1). El 58% de los pacientes recibieron infusión de milrinona. La DC se mantuvo en el grupo que recibió milrinona comparado con el grupo que no recibió (p 2.0 microns). The primary outcome was the association between changes in microcirculation and the endothelial glycocalyx related to milrinone use. Design: Prospective cohort study from February 2021 - January 2022. Place: 12-bed pediatric intensive care unit (PICU) in a university hospital. Patients: Children with sepsis/septic shock with and without milrinone infusion. Intervention: None Methods and Main Results: 140 children with a mean age of 2 years (IQR 0.58-12.1) were included. Fifty-eight percent (81/140) of patients received milrinone infusion. The main focus of infection was respiratory (43/140;30.7%). After 24 hours of administering milrinone, it was observed that capillary density (4-6 microns) was maintained only in this group (p<0.01). Children younger than two years who received milrinone had better DC4-6 than older ones (OR 0.33; CI 95% 0.12-0.89;p=0.02). In milrinone patients, capillary blood flow was more homogeneous and capillary recruitment capacity was maintained (p<0.05). Additionally, these children had less endothelial glycocalyx degradation (aOR 0.34 CI 95% 0.11-0.99; p=0.04), which was maintained despite elevated ferritin and C-reactive protein (aOR 0.41; CI 95% 0.18-0.93;p=0.03). The group without milrinone had more organ failure associated with microcirculation dysfunction, glycocalyx degradation (p<0.01) and a lower number of functional recruited capillaries (p<0.01). Elevated PBR was associated with mortality in both groups (p=0.04). Conclusions: in this investigation of children with sepsis, we found that milrinone was associated with changes in microcirculation. We found persistence of capillary recruitment of 4-6 microns after 24 hours of its administration, and maintenance and less heterogeneity of capillary blood flow as well as less degradation of the glycocalyx, particularly in children under two years of age

Regional citrate anticoagulation for continuous renal replacement therapy in children

9 páginasBackground Anticoagulation of the continuous renal replacement therapy (CRRT) circuit is an important technical aspect of this medical procedure. Most studies evaluating the efficacy and safety of citrate use have been carried out in adults, and little evidence is available for the pediatric patient population. The aim of this study was to compare regional citrate anticoagulation versus systemic heparin anticoagulation in terms of the lifetime of hemofilters in a pediatric population receiving CRRT at a pediatric center in Bogota, Colombia. Methods This was an analytical, observational, retrospective cohort study in which we assessed the survival of 150 hemofilters (citrate group 80 hemofilters, heparin group 70 hemofilters) used in a total of 3442 hours of CCRT (citrate group 2248 h, heparin group 1194 h). Hemofilter survival was estimated beginning at placement and continuing until filter replacement due to clotting or high trans-membrane pressures. Results Hemofilter survival was higher in the citrate group than in the heparin group (72 vs. 18 h; p <0.0001). Bivariate analysis showed that the hemofilter coagulation risk was significantly increased when heparin was used, regardless of hemofilter size and pump flow (hazard ratio 3.70, standard error 0.82, 95% confidence interval 2.39–5.72; p <0.00001). Conclusions Regional citrate anticoagulation could be more effective than heparin systemic anticoagulation in terms of prolonging the hemofilter lifetime in patients with acute renal injury who require CRRT