Survival Benefits of Therapeutic Plasma Exchange in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis.

Autor:	Lee OPE; Sarawak General Hospital, Kuching, Malaysia.; Birmingham Children's Hospital, Birmingham, UK., Kanesan N; Hospital Tunku Azizah, Malaysia., Leow EH; KK Women's and Children's Hospital, Singapore, Singapore., Sultana R; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore., Chor YK; Birmingham Children's Hospital, Birmingham, UK., Gan CS; Pediatric Intensive Care Unit, University Malaya Medical Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Lee JH; Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.; SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2023 Jul; Vol. 38 (7), pp. 598-611. Date of Electronic Publication: 2023 Apr 25.
DOI:	10.1177/08850666231170775
Abstrakt:	Objectives: To summarize the role of therapeutic plasma exchange (TPE) in critically ill adults and children with severe sepsis. Data Collection: A systematic search was performed using the following databases: Medline, EMBASE, CINAHL, and Cochrane from January 1990 till December 2022. Comparative studies of TPE in severe sepsis were selected. Adult and pediatric data were analyzed separately. Data Synthesis: Eight randomized control trials and 6 observational studies (n = 50,142 patients) were included. Centrifugal TPE was the most common modality (209/280, 74.6% adults and 952/1026, 92.7% children). Every TPE study utilized different volume exchanges. Most TPE sessions (1173/1306, 89.8%) employed fresh frozen plasma (FFP) as replacement fluid and heparin as anticoagulant. Adults with severe sepsis supported with TPE using FFP had lower mortality (risk ratio, RR : 0.64 [95% confidence interval, CI : 0.49, 0.84]) compared to those who did not. In contrast, TPE was associated with increased mortality in septic children without thrombocytopenia-associated multiorgan failure ( RR : 2.23, 95% CI : 1.93, 2.57). There was no difference in outcomes in patients supported with centrifugal and membrane TPE. In both populations, patients supported on TPE as a continuous regime had poorer outcome. Conclusion: Current evidence indicates that TPE is a potential adjunct therapy in adults with severe sepsis but not in children.
Databáze:	MEDLINE
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