Abstract Objective To study the role of blood purification in the treatment of severe adenovirus pneumonia. Methods A total of 57 children with severe adenovirus pneumonia who underwent mechanical ventilation from February to June, 2019, were enrolled. According to whether blood purification was performed, they were divided into a purification group with 22 children and a conventional group with 35 children. Related clinical indices were collected, including duration of fever, duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality rate. The purification group was analyzed in terms of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before blood purification and at 48 hours after blood purification, as well as stroke volume variation (SVV), thoracic fluid content (TFC), arterial partial pressure of oxygen/fraction of inhaled oxygen (P/F) value, and partial pressure of carbon dioxide (PCO2) before blood purification and at 6, 12, 24, and 48 hours after blood purification. Results Compared with the conventional group, the purification group had significantly shorter duration of fever, duration of mechanical ventilation, and length of stay in the ICU (P < 0.05), and there was no significant difference in the mortality rate between the two groups (P > 0.05). The purification group had significant reductions in IL-6 and TNF-α after blood purification, (P < 0.05) and significant reductions in SVV and TFC at 12, 24, and 48 hours after blood purification (P < 0.01), as well as a significant increase in P/F value and a significant reduction in PCO2 at 6, 12, 24, and 48 hours after blood purification (P < 0.01). Conclusions Blood purification as an auxiliary therapy can effectively improve the clinical symptoms of children with severe adenovirus pneumonia, and is thus an option for the treatment of severe adenovirus pneumonia in children.
Yoon HY, Cho HH, Ryu YJ. Adenovirus pneumonia treated with cidofovir in an immunocompetent high school senior[J]. Respir Med Case Rep, 2019, 26:215-218.
Kim SJ, Kim K, Park SB, et al. Outcomes of early administration of cidofovir in non-immunocompromised patients with severe adenovirus pneumonia[J]. PLoS One, 2015, 10(4):e0122642.
Ganapathi L, Arnold A, Jones S, et al. Use of cidofovir in pediatric patients with adenovirus infection[J]. F1000Res, 2016, 5:758.
Alobaidi R, Morgan C, Basu RK, et al. Association between fluid balance and outcomes in critically ill children:a systematic review and meta-analysis[J]. JAMA Pediatr, 2018, 172(3):257-268.
Miklaszewska M, Korohoda P, Zachwieja K, et al. Factors affecting mortality in children requiring continuous renal replacement therapy in pediatric intensive care unit[J]. Adv Clin Exp Med, 2019, 28(5):615-623.
Arikan AA, Zappitelli M, Goldstein SL, et al. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children[J]. Pediatr Crit Care Med, 2012, 13(3):253-258.
Ingelse SA, Wiegers HM, Calis JC, et al. Early fluid overload prolongs mechanical ventilation in children with viral-lower respiratory tract disease[J]. Pediatr Crit Care Med, 2017, 18(3):e106-e111.
Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock[J]. Crit Care Med, 2017, 45(6):1061-1093.
Zakariás D, Marics G, Kovács K, et al. Clinical application of the electric cardiometry based non-invasive ICON® hemodynamic monitor[J]. Orv Hetil, 2018, 159(44):1775-1781.
Della Rocca G, Costa MG. Hemodynamic-volumetric monitoring[J]. Minerva Anestesiol, 2004, 70(4):229-232.
Yi L, Liu Z, Qiao L, et al. Does stroke volume variation predict fluid responsiveness in children:a systematic review and meta-analysis[J]. PLoS One, 2017, 12(5):e0177590.
van de Water JM, Mount BE, Chandra KM, et al. TFC (thoracic fluid content):a new parameter for assessment of changes in chest fluid volume[J]. Am Surg, 2005, 71(1):81-86.
Guidotti LG, Chisari FV. Noncytolytic control of viral infections by the innate and adaptive immune response[J]. Annu Rev Immunol, 2001, 19:65-91.
Fu Y, Tang Z, Ye Z, et al. Human adenovirus type 7 infection causes a more severe disease than type 3[J]. BMC Infect Dis, 2019, 19(1):36.
Nakamura H, Fujisawa T, Suga S, et al. Species differences in circulation and inflammatory responses in children with common respiratory adenovirus infections[J]. J Med Virol, 2018, 90(5):873-880.
Chen LX, Demirjian S, Udani SM, et al. Cytokine clearances in critically ill patients on continuous renal replacement therapy[J]. Blood Purif, 2018, 46(4):315-322.
Park JT, Lee H, Kee YK, et al. High-dose versus conventional-dose continuous venovenous hemodiafiltration and patient and kidney survival and cytokine removal in sepsis-associated acute kidney injury:a randomized controlled trial[J]. Am J Kidney Dis, 2016, 68(4):599-608.
Quinto BM, Iizuka IJ, Monte JC, et al. TNF-α depuration is a predictor of mortality in critically ill patients under continuous veno-venous hemodiafiltration treatment[J]. Cytokine, 2015, 71(2):255-260.