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"In-Series" Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange: Single-Center Retrospective Cohort,
Rachel H Williams1, Bradley G Carter1, Mathilde Escudie1
1Paediatric and Neonatal Intensive Care Units, Royal Children's Hospital, Melbourne, VIC, Australia.
Summary
This study shows an "in-series" approach for simultaneous continuous renal replacement therapy (CRRT) and therapeutic plasma exchange (TPE) is safe and effective. The method reduced circuit usage by 71% and minimized complications in pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Extracorporeal Therapies
Background:
- Patients requiring both continuous renal replacement therapy (CRRT) and therapeutic plasma exchange (TPE) present unique treatment challenges.
- Integrating these therapies efficiently is crucial for optimizing patient outcomes and resource utilization.
Purpose of the Study:
- To describe the successful implementation and outcomes of an "in-series" approach for combined CRRT and TPE in pediatric patients.
- To evaluate the safety, efficacy, and resource implications of this integrated extracorporeal circuit configuration.
Main Methods:
- A retrospective review of case notes was conducted for pediatric patients (0-18 years) who underwent combined CRRT and TPE between 2018 and 2022.
- The study focused on an "in-series" setup utilizing existing access and a single device for both therapies.
Main Results:
- Twelve pediatric patients received 32 TPE and 38 CRRT sessions using the in-series approach.
- This method resulted in a significant 71% reduction in standard extracorporeal circuit usage.
- The setup required 20 extracorporeal circuits and 11 additional plasma filters/hemofilters.
Conclusions:
- The "in-series" CRRT and TPE approach is safe and effective, with no unexpected adverse events reported.
- This integrated method enhances treatment efficiency, reduces infection risk, minimizes circuit exposure, and decreases hemodilution and blood product usage.
- Potential cost and waste reductions were also observed, highlighting the approach's resource-sparing benefits.
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