# Integration of Polymyxin-B Hemoadsorption Device into a CRRT Circuit for Endotoxic Septic Shock in a Child: A Case Report

## TL;DR

A 9-year-old boy with septic shock was successfully treated using a modified method that combined a Toraymyxin® device with CRRT, avoiding complications and improving recovery.

## Contribution

Demonstrates a novel, safe integration of Toraymyxin® into CRRT for pediatric septic shock.

## Key findings

- The integration minimized extracorporeal volume expansion and avoided circuit replacement.
- The patient showed rapid improvement and was transferred out of intensive care within 28 days.
- The approach supports hemodynamic stabilization without additional vascular access.

## Abstract

Introduction: Endotoxin-mediated septic shock is a life-threatening condition characterized by systemic inflammation and hemodynamic instability. While Polymyxin-B hemoadsorption (Toraymyxin®) 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® 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® cartridge into an ongoing CRRT circuit in pediatric septic shock, minimizing extracorporeal volume, avoiding additional vascular access, and supporting hemodynamic stabilization.