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

<b>Introduction</b>: 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. <b>Case Presentation</b>: 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. <b>Conclusions</b>: 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.