{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T13:55:50Z","timestamp":1793022950537,"version":"4.5.0"},"reference-count":8,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Introduction: Endotoxin-mediated septic shock is a life-threatening condition characterized by systemic inflammation and hemodynamic instability. While Polymyxin-B hemoadsorption (Toraymyxin\u00ae) is well-studied in adults, its use in pediatric patients remains less explored and requires modified approaches to minimize invasiveness and complications. Case Presentation: We report a 9-year-old boy (25 kg) with endotoxin-mediated septic shock due to Klebsiella pneumoniae, who developed oliguric acute kidney injury requiring continuous renal replacement therapy (CRRT). On Day 4, worsening conditions prompted the initiation of Toraymyxin\u00ae treatment, directly integrated into the ongoing CRRT circuit. This approach minimized extracorporeal volume expansion, avoided circuit replacement, and was complication-free. The patient improved rapidly, allowing CRRT discontinuation and transfer to the ward within 28 days. Conclusions: This case highlights the feasibility, safety, and potential benefits of integrating the Toraymyxin\u00ae cartridge into an ongoing CRRT circuit in pediatric septic shock, minimizing extracorporeal volume, avoiding additional vascular access, and supporting hemodynamic stabilization.<\/jats:p>","DOI":"10.3390\/pediatric18020037","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:51:33Z","timestamp":1772614293000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integration of Polymyxin-B Hemoadsorption Device into a CRRT Circuit for Endotoxic Septic Shock in a Child: A Case Report"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1881-9989","authenticated-orcid":false,"given":"Giovanni","family":"Ceschia","sequence":"first","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Woman\u2019s and Child\u2019s Health, University-Hospital of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0026-8945","authenticated-orcid":false,"given":"Germana","family":"Longo","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Woman\u2019s and Child\u2019s Health, University-Hospital of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M. Igeno San","family":"Miguel","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Woman\u2019s and Child\u2019s Health, University-Hospital of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3127-8836","authenticated-orcid":false,"given":"Marco","family":"Daverio","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Unit, Department of Woman\u2019s and Child\u2019s Health, University-Hospital of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3963-0803","authenticated-orcid":false,"given":"Enrico","family":"Vidal","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Unit, Department of Woman\u2019s and Child\u2019s Health, University-Hospital of Padova, 35128 Padova, Italy"},{"name":"Department of Medicine (DMED), University of Udine, 33100 Udine, Italy"},{"name":"Institute of Pediatric Research \u201cCitt\u00e0 della Speranza\u201d, 35127 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Foster, D.M., and Kellum, J.A. (2023). Endotoxic Septic Shock: Diagnosis and Treatment. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242216185"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.1001\/jama.2009.856","article-title":"Early use of polymyxin B hemoperfusion in abdominal septic shock: The EUPHAS randomized controlled trial","volume":"301","author":"Cruz","year":"2009","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1001\/jama.2018.14618","article-title":"Effect of Targeted Polymyxin B Hemoperfusion on 28-Day Mortality in Patients with Septic Shock and Elevated Endotoxin Level: The EUPHRATES Randomized Clinical Trial","volume":"320","author":"Dellinger","year":"2018","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1007\/s00134-018-5463-7","article-title":"Polymyxin B hemoperfusion in endotoxemic septic shock patients without extreme endotoxemia: A post hoc analysis of the EUPHRATES trial","volume":"44","author":"Klein","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1007\/s12519-020-00350-8","article-title":"Polymyxin for the treatment of intracranial infections of extensively drug-resistant bacteria in children after neurosurgical operation","volume":"16","author":"Ye","year":"2020","journal-title":"World J. 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Nephrol."}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/2\/37\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T09:42:50Z","timestamp":1772617370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/2\/37"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":8,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["pediatric18020037"],"URL":"https:\/\/doi.org\/10.3390\/pediatric18020037","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]}}}