Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications.
Child
Child, Preschool
Continuous Renal Replacement Therapy
/ statistics & numerical data
Critical Illness
Extracorporeal Membrane Oxygenation
/ statistics & numerical data
Female
Humans
Infant
Intensive Care Units, Pediatric
Male
Multiple Organ Failure
/ etiology
Plasma
Plasma Exchange
/ adverse effects
Respiration, Artificial
/ statistics & numerical data
Retrospective Studies
Sepsis
/ therapy
Survival Rate
acute disseminated encephalomyelitis
multiorgan dysfunction syndrome
pediatric intensive care
sepsis
therapeutic plasma exchange
thrombotic microangiopathy
Journal
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
ISSN: 1744-9987
Titre abrégé: Ther Apher Dial
Pays: Australia
ID NLM: 101181252
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
20
09
2019
revised:
12
12
2019
accepted:
07
01
2020
pubmed:
11
1
2020
medline:
15
12
2020
entrez:
11
1
2020
Statut:
ppublish
Résumé
Therapeutic plasma exchange (TPE) is an effective treatment method in selective indications. Secondary to access and technical features, it is more difficult to apply in pediatric population than adults. The aim of this study is investigate safety, clinical indications, and results of this method in critically ill pediatric patients who need TPE treatment. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 4 years (2015-2019) were evaluated retrospectively. TPE procedures (635) were performed for 135 patients. Median age was 34 months (10-108). Ninety-seven patients had mechanical ventilation support. Sepsis with multiple organ failure was the most frequent indication and accounted for 44.4% (n = 60) of the indications followed by hematological and neurological diseases (19.2% and 9.6% respectively). TPE was performed alone in 469 cases (73.9%), in combination with continuous renal replacement therapy in 154 cases (24.2%), and additional to extracorporeal membrane oxygenation in 12 cases (1.9%). Hematological disease and sepsis subgroups had the highest intubation rate, mechanical ventilation period, PRISM score, organ failure count, and mortality. Fresh frozen plasma (FFP) was the most frequently used replacement fluid in 90.4% of the procedures. The most frequent anticoagulant used in TPE was acid citrate dextrose solution (79.3%). Procedural complications were detected in 104 cases (16.3%) and occurred during TPE sessions. Overall survival rate was 78.5%. We found that the non-survivor group had significantly higher rates of organ failures (P = 0.0001), higher PRISM scores on admission (P = 0.0001), and higher rates of invasive ventilation support needed (P = 0.012). TPE is a treatment method which can be safely provided in healthcare facilities with necessary medical and technical requirements. Although it is riskier to provide such treatment to critically ill children, complications can be minimized in experienced healthcare facilities. Overall results are good and can vary depending on indication.
Identifiants
pubmed: 31922326
doi: 10.1111/1744-9987.13474
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
221-229Informations de copyright
© 2020 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.
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