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Therapeutic plasma exchange in the pediatric intensive care unit: A single-center 5-Year experience

Muhterem Duyu1, Ceren Turkozkan2

  • 1Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.

Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis
|October 4, 2020
PubMed

Insights

Therapeutic plasma exchange (TPE) is relatively safe in critically ill children. Survival rates vary by indication, with TPE-only patients showing high survival, while those with sepsis-induced multiple organ dysfunction syndrome had lower rates.

Area of Science:

  • Pediatric Critical Care Medicine
  • Apheresis
  • Extracorporeal Therapies

Background:

  • Critically ill children often require advanced therapies for multi-organ dysfunction.
  • Therapeutic plasma exchange (TPE) is an extracorporeal procedure used in severe pediatric conditions.
  • Understanding TPE's role, safety, and outcomes in pediatric intensive care units (PICUs) is crucial.

Purpose of the Study:

  • To characterize clinical indications for TPE in critically ill children.
  • To evaluate the safety and outcomes of TPE in a pediatric intensive care unit (PICU) setting.
  • To analyze survival rates based on TPE use and underlying conditions.

Main Methods:

  • Retrospective evaluation of all TPE procedures in a tertiary PICU over 5 years.
  • Analysis of patient demographics, indications, American Society for Apheresis ( ) classifications, and adjunct therapies (continuous renal replacement therapy [CRRT], extracorporeal membrane oxygenation [ECMO]).
  • Assessment of overall survival rates, complication rates, and factors influencing outcomes.

Main Results:

  • A total of 75 patients underwent 249 TPE sessions; sepsis-induced multiple organ dysfunction syndrome (MODS) was the most common indication (29.3%).
  • Overall survival was 73.3%; survival was higher for TPE-only (86.5%) compared to those requiring CRRT (45%) or ECMO (33.3%).
  • Complications occurred in 19.2% of sessions; sepsis-induced MODS had the lowest survival rate (31.9%).

Conclusions:

  • Therapeutic plasma exchange (TPE) can be performed relatively safely in critically ill children when indicated.
  • Survival rates are influenced by the underlying disease and requirement for adjunctive therapies like CRRT and ECMO.
  • Children requiring TPE alone demonstrate a very high survival rate, highlighting its efficacy in specific pediatric critical care scenarios.

Keywords:
ComplicationsIndicationsPediatric intensive careTherapeutic plasma exchange

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