Workshop 2 - Session F
Abstract List
20 Sep 2026
14:00
15:30
Room 2
Pediatric Extracorporeal Therapies: From Basics to Advanced Clinical Challenges
I-Jung Tsai
Moderator
Beyond Renal Replacement: Advanced Extracorporeal Blood Purification in Pediatric SepsisSepsis and hyperinflammatory syndromes remain leading causes of mortality in critically ill children, frequently complicated by multiorgan dysfunction syndrome and acute kidney injury. While continuous kidney replacement therapy (CKRT) is the cornerstone for managing fluid overload and solute clearance, standard modalities cannot adequately address the underlying dysregulated immune response driven by a profound cytokine storm. Recently, a significant paradigm shift has occurred in critical care nephrology, transitioning from conventional renal support toward advanced extracorporeal blood purification (EBP) techniques. Current literature emphasizes the clinical benefits of actively removing endotoxins and excessive cytokines to restore immune homeostasis. Modalities utilizing hemoadsorption membranes have demonstrated promising outcomes in adult studies, showing rapid hemodynamic stabilization and successful modulation of inflammatory markers in septic shock. However, literature regarding EBP in pediatric populations remains notably sparse. This knowledge gap is largely attributed to the physiological and technical challenges of pediatric care, particularly the high risks of hemodynamic instability associated with large extracorporeal circuit volumes in children weighing less than 10 kilograms. Standardized protocols for pediatric EBP are still lacking, necessitating cautious technical adaptations, such as targeted blood priming strategies. This presentation will review the current literature on EBP in sepsis, explore the physiological rationale behind targeted hemoadsorption, and discuss the practical challenges of applying these therapies in pediatrics. By moving beyond traditional renal replacement, we aim to highlight how integrating advanced blood purification into pediatric CKRT can safely modulate systemic inflammation, potentially improving clinical outcomes for vulnerable critically ill children.
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14:00
15:30
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Ting-Yuan Chang
Speaker
The Critical Initiation: Circuit Priming & Hemodynamic ManagementThis workshop addresses the critical first steps of initiating continuous kidney replacement therapy (CKRT) in pediatric patients. Topics include selecting an appropriate CKRT machine, determining hemofilter size, and designing the extracorporeal circuit. Special emphasis is placed on preventing hemodynamic instability during blood priming and circuit initiation, including calculation of the patient's circulating blood volume relative to the extracorporeal volume to avoid hypovolemic shock from excessive extracorporeal blood sequestration. Participants will learn practical decision-making frameworks for safe circuit priming strategies tailored to children of different body sizes.
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Shotaro Matsumoto
Speaker
The Ultimate Support: Heart-Lung-Kidney Crosstalk and ECMO-CRRT Integration in PediatricsCore Decisions: Modality Selection (CVVH / CVVHD / CVVHDF) & Prescription
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Jhao-Jhuang Ding
Speaker
Advanced Purification: Therapeutic Plasma Exchange (TPE) Concepts & ChallengesTherapeutic plasma exchange (TPE) is the most widely used therapeutic apheresis modality in critically ill children, yet it remains technically demanding and conceptually distinct from diffusion- and convection-based renal replacement. This hands-on station reviews the core principles of TPE—one-compartment kinetics, the rationale for a 1.0–1.5 plasma-volume exchange, and how molecular size and protein binding determine what TPE can and cannot remove—and links them to evidence-based indications from the ASFA guidelines relevant to pediatric practice (e.g., thrombotic microangiopathies, ANCA-associated and anti-GBM disease, autoimmune neurologic disease, and liver failure). Emphasis is placed on the practical challenges unique to children: vascular access and circuit sizing, blood priming for small patients, choice of replacement fluid (albumin vs. fresh frozen plasma), anticoagulation with citrate versus heparin, and the recognition and management of complications such as hypocalcemia, coagulopathy, and hemodynamic instability. Through short clinical cases, participants will practice prescribing and troubleshooting TPE at the bedside.
By the end of this station, participants will be able to: 1. Explain the pharmacokinetic basis of TPE and justify the prescribed exchange volume and frequency. 2. Select appropriate ASFA-supported indications for TPE in pediatric AKI/critical-care settings and distinguish TPE from CRRT modalities. 3. Prescribe TPE for a child—vascular access, replacement fluid, anticoagulation—and adjust for body size. 4. Recognize and manage common complications (hypocalcemia, coagulopathy, hypotension, reactions).
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