Plasma exchange in the intensive care unit: Technical aspects and complications

Area of Science:

• Critical Care Medicine
• Nephrology
• Hematology

Background:

• Limited data exist on plasma exchange (PEX) in the intensive care unit (ICU).
• Understanding PEX technical aspects and adverse events in critically ill patients is crucial.

Purpose of the Study:

• To describe the technical aspects of PEX in critically ill patients.
• To report adverse events associated with PEX in the ICU setting.

Main Methods:

• Prospective study of adult patients undergoing PEX in a medical ICU.
• Data collected on centrifugation and filtration techniques, efficacy, and adverse events.

Main Results:

• 260 PEX procedures in 50 patients; centrifugation (61%) and filtration (39%) techniques used.
• Similar efficacy for hyperviscosity syndrome; 26.9% of procedures had adverse reactions.
• Hypotension and allergic reactions were most common; filter clotting occurred in 22.8% of filtration procedures.

Conclusions:

• Plasma exchange is a generally safe and well-tolerated procedure in the ICU.
• Most adverse events are minor and unpredictable, often related to replacement fluids.
• Centrifugation and filtration techniques demonstrate comparable safety and efficacy profiles.