IMPORTANCE: Important advances have been made in extracorporeal blood purification therapies (EBPTs) due to new technologies and biomaterials; however, the lack of established guidelines is a factor in great variability in clinical practice. This aspect is accentuated in pediatric intensive care given the small number of patients with diverse diagnoses treated with EBPT and the technical challenges in treating small children, potentiating the risk of adverse events. OBJECTIVE: To understand what experienced users of EBPT think about its relevant issues, insight that may have implications for the design of future studies, and the application of EBPTs in patient care. EVIDENCE REVIEW: Literature search was conducted using the PubMed and Embase databases between January 1, 2020, and July 15, 2024, and a combination of key medical terms. A panel of experts was formed (composed of 15 authors and pediatric intensivists) to develop a consensus statement using a modified Delphi-based model between 2022 and 2024. The panel's core team drafted the initial questionnaire, which explored EBPT use in pediatric intensive care units (PICUs), including clinical indications for initiating and discontinuing use and outcomes for assessing effectiveness and safety. SurveyMonkey was used in the distribution, completion, and revision of the questionnaire, and findings were analyzed. Panelists were asked to rank answer choices. Numerical value for each ranking was translated to a percentage defining the strength of consensus (>90% agreement from panelists signifying strong consensus; <49% signifying no consensus). FINDINGS: A total of 116 survey responses were received from panelists from 8 European countries. Strong consensus was achieved on 6 of 24 questions and consensus (75%-90% agreement) was reached on 18 of 24 questions. According to the panelists, the continuous renal replacement therapy standard or enhanced adsorption hemofilter and plasma exchange were of interest, representing the most applied EBPTs across various applications. While evidence on hemoadsorption is growing, it remains limited. CONCLUSIONS AND RELEVANCE: This consensus statement on EBPTs in critically ill pediatric patients was developed by an international panel of experts in areas where clinical evidence is still limited. This consensus statement could support pediatric intensivists in bedside decision-making and guide future research on EBPTs in PICUs.

Child Health Research Centre The University of Queensland Brisbane Queensland Australia

Consultant in Paediatric Intensive Care Medicine Oxford University Hospitals National Health Service Foundation Trust United Kingdom

Department of Intensive Care and Neonatology and Children's Research Center University Children's Hospital Zurich University of Zurich Zurich Switzerland

Department of Pediatric Intensive Care Center for Life Support Practice and Research Hacttepe University Ankara Türkiye

Department of Pediatric Intensive Care Istanbul Faculty of Medicine Istanbul Türkiye

Faculty of Medicine Paris Saclay University France

Imperial College London London United Kingdom

Institute of Integrative Biology of the Cell Centre National de la Recherche Scientifique Commissariat à L'énergie Atomique et aux Énergies Alternatives Paris Saclay University Gif sur Yvette France

Neonatal and Pediatric Intensive Care Unit Emergency Department Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini Genova Italy

Neonatal Intensive Care Unit Health Local Authority 3 of Pescara Pescara Italy

Pediatric and Neonatal Intensive Care Unit Bicetre Hospital Assistance Publique Hôpitaux de Paris Paris Saclay Le Kremlin Bicetre France

Pediatric Intensive Care AP HP Paris Saclay University Bicêtre Hospital Le Kremlin Bicêtre France

Pediatric Intensive Care Unit Bambino Gesù Children's Hospital Rome Italy

Pediatric Intensive Care Unit Department of Pediatrics University Hospital and Faculty of Medicine Ostrava Czech Republic

Pediatric Intensive Care Unit Gregorio Marañón University Hospital Gregorio Marañón Health Research Institute Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network RD21 0012 0011 Carlos 3 Health Institute Madrid Spain

Pediatric Intensive Care Unit King's College Hospital London United Kingdom

Pediatric Intensive Care Unit University Children's Hospital at Haunersche Kinderklinik Ludwig Maximilian University of Munich Munich Germany

Pediatric Intensive Care Unit University Hospital School of Medicine University of Crete Heraklion Greece

Postgraduate Program Emergency and Intensive Care in Children Adolescents and Young Adults School of Medicine University of Crete Heraklion Greece

References provided by Crossref.org