• Naoyuki Hirata, Dong Tien Ngo, Phuc Huu Phan, Akira Ainai, Thuy Thi Bich Phung, Tuan Anh Ta, Jin Takasaki, Shoji Kawachi, Hiroyuki Nunoi, Noriko Nakajima, and Tran Minh Dien.
• Department of Anesthesiology, Sapporo Medical University School of Medicine, S1 W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. naohirata@mac.com.
• J Anesth. 2021 Oct 1; 35 (5): 638-645.

PurposeRecombinant 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.MethodsSix 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.ResultsIn 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.ConclusionsThe rTM administration is feasible as an adjunctive therapeutic strategy for children over 2 months with pneumonia-induced severe ARDS complicated by DIC.© 2021. Japanese Society of Anesthesiologists.

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