On-line plasma exchange for sepsis in neonates and infants

The present study was designed to assess the effectiveness of on-line plasma exchange (on-line P.E.) between septic infants and healthy adults using septic puppies. The plasma separation system consisted of a membrane plasma separator and a plasma treatment system, KM-9027 (Kurarey Co.) equipped with small 2 channel blood and plasma pumps. 5 X 10(9) CFU/ml/kg of E. coli with endotoxin was injected intravenously into 22 puppies and they were divided into 4 groups, namely untreated group (n = 7), on-line P.E. group (n = 5), P.E. group (n = 5), sham group (n = 5). In the on-line P.E. group, about 80 ml/kg of plasma in septic puppy was replaced during 2 hr with fresh plasma simultaneously obtained from healthy adult dog. As the results, 4 of 5 survived in the on-line P.E. group and 1 of 5 survived in the P.E. group, while all other puppies died within 24 hr. In the P.E. group and on-line P.E. group, mean blood pressure and urinary output were significantly improved (p less than 0.05) by the treatment. The numbers of E. coli and endotoxin concentration in the blood were reduced significantly (p less than 0.05) only in the treatment with on-line P.E. opsonic activity recovered significantly (p less than 0.05) in P.E. group. This system appears to be effective and applicable for sepsis in infants and neonates.