Solution available in the current era.
Severe Acute Malnutrition status and hypo- P-271
albuminemia are associated with increased risk of death in these patients.
P-269
BLOOD PURIFICATION TREATMENT FOR SEVERE CYTO-
KINE RELEASE SYNDROME AFTER CHIMERIC ANTIGEN
RECEPTOR T CELL THERAPY: CASE REPORT AND LITERA-
TURE REVIEW.
X. Long1
1
Shanghai Children’s Medical Center, PICU, Shanghai, China
Aims & Objectives:
To evaluate the effectiveness of Blood Purification treatment for Severe Cytokine
Release Syndrome after Chimeric Antigen Receptor T cell Therapy in pediatrics
relapsed acute lymphoblastic leukemia.
Downloaded from http://journals.lww.com/pccmjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 09/24/2021
Methods
We reported a case of 11 years old boy with relapsed ALL developed the severe
CRS rapidly after treated with CAR-T therapy and reviewed the literature.
Results
The boy developed to severe cytokine-release syndrome rapidly after treated with
CAR-T cellular therapy within 3 days. The CRS was characterized as high fever,
hypotension, capillary leakage, edema and high IL-6 level in blood (20587pg/
ml). After the failure of the anti-IL-6 antibody treatment, this patient was treated
with blood purification combined with plasma exchange and CVVHDF in emer-
gency, and the CRS was ultimately controlled. This paper reported the treatment
process of rapid introduction of blood purification therapy for severe CRS in
PICU, By searching the literature, we found that severe CRS patients required
intensive care with respiratory support (nasal cannula or mechanical ventila-
tion) and vasopressor support. Serum IL-6 levels was positive collected with the
severity of CRS after CAR-T-cell Therapy. Anti-IL-6 antibody therapy has been
recommended for severe CRS, but seldom literature reported blood purification
used in severe CRS.
Conclusions
Blood purification has advantage of eliminated inflammatory cytokines for the
treatment of CRS after CAR-T.We provided a promising alternative to treating
severe CRS after the failure of conventional therapy such as anti-IL-6 antibody
treatment in CAR-T therapy patients.
P-270
CROHN’S DISEASE IN A YOUNG BOY: A CASE REPORT FROM
TERTIARY HOSPITAL IN MEDAN
A. lubis1, A. dauhan1, M. lubis1
1
Faculty of Medicine Universitas Sumatera Utara, pediatric, Medan, Indonesia
Aims & Objectives:
Along with ulcerative colitis, Crohn’s disease is one of a group disease known as
inflammatory bowel disease. Crohn’s disease is a rare in pediatric population. It
most common through people who are between the ages fifteen and thirty. Mani-
festation in pediatric are more severe than adult and need long term management.
In Indonesia, the symptom usually diagnosed with inflammatory bowel disease
not specified Crohn’s disease.
Methods
A case report of a 6 year old boy with Crohn’s disease.
Results
A 6 year old boy was admitted at Universitas Sumatera Utara Hospital due to
haemmorhagic shock. He complained of massive blood discharge from anal
for three days. Since one month prior to admission, he got fever, mouth sores,
and abdominal pain. No family history with the same symptoms was recorded.
Abdominal ultrasonography and scanning showed normal results. Crohn’s dis-
ease was diagnosed from endoscopy biopsy. Hence, prednisolone was started and
fentanyl drip was given as his pain management. He only consumed specific pow-
dered formula which processed to retain TGF-β2 daily. Absess perianal was noted
one month after Crohn’s disease has been diagnosed and it was drainaged. Specific
therapy of Tumor Necrosis Factor Blockers was given. The sign and symptoms
significantly improved.
Conclusions
Crohn’s disease in children with appropriate diagnosis and therapy has good
prognosis.
Pediatric Critical Care Medicine 2018 • Volume 19 • Number 6 (Suppl.)
Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Unauthorized reproduction of this article is prohibited
MULTIPLE ORGAN DYSFUNCTION SYNDROME INDUCED
BY BEE STINGS IN A 4 YEAR OLD FEMALE
M. Lubis1, R. Puspitasari1, R.A.C. Saragih1, A. Lubis1, G.N. Yanni1, I.N. Lestari1
Faculty of Medicine- University of Sumatera Utara, Pediatric, Medan, Indonesia
1
Aims & Objectives:
Multiorgan dysfunction after bee stings are extremely rare. The severity and dura-
tion of reaction varies from one person to another depending on location and
number of bee stings received. The mechanisms underlying bee sting injury may
comprise the direct toxic effect of venom and immune inflammatory reaction to
venom composition, both of which can lead to organ failure.
Methods
A case report on multiple organ dysfunction syndrome due to mass envenom-
ation of bee stings in children.
Results
A 4 year old female was admitted at University of Sumatera Utara Hospital suf-
fering of sepsis, pneumonia, renal and liver failure after she was stung by a hive
of bees on three days prior to admission. Multiple erythematous nodules and
pustules were noted all over her body, associated with cough, icteric, hematu-
ria, dyspnea, edema on the face, neck, and extremities. She was tachycardia and
tachypnea on arrival with normotensive and good perfusion. Oliguria was noted.
Laboratory result revealed leukocytosis, thrombocytopenia, metabolic acidosis
with renal and liver impairment. Chest x-ray result showed pneumonia. Systemic
corticosteroid and diphenhydramine were given. Ceftriaxone was started then
shifted to Meropenem due to persistence sign and symptoms. She was improved
after ten days. The major clinical characteristics of this patient were reactions of
the bee venom toxicity which attributed to vasodilatory, nephrotoxic and hepa-
totoxic enzymes.
Conclusions
Multiple bee stings are fatal and may lead to multiple organ dysfunction.
P-272
TRIPLE SITE REGIONAL TISSUE OXYGENATION USING
NEAR-INFRARED SPECTROSCOPY MONITORING FOR
ISCHAEMIC INJURY IN CHILDREN FOLLOWING CONGENI-
TAL CARDIAC SURGERY – A PILOT STUDY
I. Macleod1, J. Watson2, L. Hannah2, M. Davidson1
1
Royal Hospital for Children, Paediatric Intensive Care, Glasgow, United Kingdom
2
University of the West of Scotland, School of Health- Nursing and Midwifery, Ham-
ilton, United Kingdom
Aims & Objectives:
To establish feasibility of a study to test hypothesis that splanchnic tissue oxygen-
ation (rSO2) in infants <6months of age during the first 48hours following car-
diac surgery is lower in those on the ‘High Risk Abdomen’ (HRA) versus standard
enteral nutrition management guideline.
Objectives:
1. To evaluate clinical utility of NIRS monitoring and correlation with Acute
Kidney Injury (AKI) and gastro-intestinal dysfunction, including Necro-
tising Enterocolitis (NEC).
2. To establish correlation between renal and splanchnic rSO2 in infants fol-
lowing cardiac surgery in comparison to cerebral rSO2.
Methods
Single centre prospective pilot study utilising quota sampling.
Results
An 87.5% recruitment rate was achieved. Seven infants with biventricular physi-
ology, median age 53days (IQR: 9–116), 3.62kg (IQR: 3.1–5.2), 57% RACHS
score ≥3. Of the potential 60480 rSO2 data points, 87% recorded.
Two patients managed on the HRA guideline demonstrated a trend of; longer
CPB time, higher maximum lactate and vasoactive inotrope score (figure 1). No
participants diagnosed with NEC, 57% with enteral feed intolerance and one
with acute kidney injury.
Renal and splanchnic rSO2 linear correlation was stronger than that of cere-
bral and renal rSO2 or cerebral and splanchnic rSO2 (figure 2 and 3). However,
Pearson’s coefficient demonstrated variable magnitude of correlation between
renal and splanchnic rSO2 and linear regression identified that the variation in
splanchnic rSO2 is not strongly related to changes in renal rSO2.