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Hirata N, Ngo DT, Phan PH, Ainai A, Phung TTB, Ta TA, Takasaki J, Kawachi S, Nunoi H, Nakajima N, Dien TM. Recombinant human thrombomodulin for pneumonia-induced severe ARDS complicated by DIC in children: a preliminary study. J Anesth 2021; 35:638-645. [PMID: 34259911 PMCID: PMC8278185 DOI: 10.1007/s00540-021-02971-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022]
Abstract
Purpose Recombinant human soluble thrombomodulin (rTM) has been used to treat disseminated intravascular coagulation (DIC). Recent studies have shown the efficacy of rTM through its anti-inflammatory effects for treatment of adults with acute respiratory distress syndrome (ARDS). However, the safety and efficacy of rTM in children with severe ARDS complicated by DIC have not been reported. In this preliminary study, we reported the feasibility of using rTM for the treatment of pneumonia-induced severe ARDS complicated by DIC in children. Methods Six children (age: median 10 months old) with pneumonia-induced severe ARDS complicated by DIC were enrolled in this preliminary study. rTM (380 U/kg) was administered for a maximum of 6 days, in addition to conventional therapies after diagnosis of severe ARDS complicated by DIC. After administration of rTM, we measured changes in the plasma TM concentration and evaluated the clinical course, status of DIC and ARDS, and other laboratory findings, including levels of cytokines, chemokines, and biomarkers. Results In all six children, the plasma concentration of TM increased and DIC scores decreased after administration of rTM. Four of the six children recovered from the severe ARDS complicated by DIC after treatment, and were discharged from the hospital with no complications. In survived children, levels of soluble receptors for advanced glycation end products, interleukin-6, interleukin-8 and monocyte chemotactic protein-1 decreased after administration of rTM compared to those before rTM. Conclusions The rTM administration is feasible as an adjunctive therapeutic strategy for children over 2 months with pneumonia-induced severe ARDS complicated by DIC. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02971-3.
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Affiliation(s)
- Naoyuki Hirata
- Department of Anesthesiology, Sapporo Medical University School of Medicine, S1 W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Dong Tien Ngo
- Department of Pediatrics Intensive Care Units, National Children's Hospital, 18 ngõ 879 Đường La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
| | - Phuc Huu Phan
- Department of Pediatrics Intensive Care Units, National Children's Hospital, 18 ngõ 879 Đường La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
| | - Akira Ainai
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Thuy Thi Bich Phung
- Department of Molecular Biology for Infectious Disease, National Children's Hospital, 18 ngõ 879 Đường La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
| | - Tuan Anh Ta
- Department of Pediatrics Intensive Care Units, National Children's Hospital, 18 ngõ 879 Đường La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
| | - Jin Takasaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8622, Japan
| | - Shoji Kawachi
- Division of the Asia International Institute of Infection Disease Control, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hiroyuki Nunoi
- Aisenkai Nichinan Hospital, 3649-2 Kazeta, Nichinan, Miyazaki, 887-0034, Japan
| | - Noriko Nakajima
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Tran Minh Dien
- Department of Surgical Intensive Care Unit, National Children's Hospital, 18 ngõ 879 Đường La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
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