Therapeutic plasma exchange in critically ill children: 18-year experience of a tertiary care paediatric intensive care unit.

Autor: Ekinci F; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: farukekinci83@gmail.com., Yildizdas D; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: dyildizdas@gmail.com., Horoz OO; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: oozgurhoroz@yahoo.com., Yontem A; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: drayontem@gmail.com., Acar IH; Department of Internal Medicine, Division of Hematology, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: halil_acar_63@hotmail.com., Karadamar M; Plasmapheresis Department, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: meltemkrdmr@hotmail.com., Guvenc B; Department of Internal Medicine, Division of Hematology, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address: guvenc.birol@gmail.com.
Jazyk: angličtina
Zdroj: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses [Aust Crit Care] 2024 Jul; Vol. 37 (4), pp. 592-599. Date of Electronic Publication: 2024 Feb 07.
DOI: 10.1016/j.aucc.2023.12.006
Abstrakt: Background: Therapeutic plasma exchange (TPE) has been used as a primary or supportive treatment in critical paediatric patients during the clinical course of many diseases.
Objectives: The objective of this study was to characterise the indications, complications, and outcomes of critically ill children who received TPE in a tertiary referral paediatric intensive care unit (PICU).
Methods: This retrospective observational study was conducted in a tertiary referral 13-bed PICU of a university hospital. Critically ill children, who received at least one TPE procedure, were retrospectively included in the study. TPE was utilised by the same paediatric intensivist in accordance with the American Society for Apheresis (ASFA) guideline between January 2005 and December 2022. The procedures were analysed in terms of technical aspects and complications. Multivariable logistic regression analysis was performed to identify independent risk factors for mortality.
Results: In total, 1528 TPE sessions were performed on a total of 328 children. The overall TPE utility rate was 25 per 1000 PICU admissions. Primary indications for TPE were sepsis, neurological autoimmune, haematological diseases, acute liver failure, drug overdose, and autoimmune rheumatological disorders in 109 (33.2%), 90 (27.4%), 49 (14.9%), 43 (13.1%), 12 (3.7%), and 10 (3%) of patients, respectively. The distribution of TPE indications according to ASFA categories was as follows: 37 patients (11.3%) were in category I, 44 patients (13.4%) were in category II, and 211 (64.3%) were in category III. Complications were observed in 18.7% of sessions, and the most common complications were haemodynamic (10.8%) and circuit-/catheter-related (7.6%) complications. The mortality rate was 28.4% in the study. Moreover, both Pediatric Index of Mortality 3 score and number of organ failures were found as independent risk factors for mortality.
Conclusions: Our results revealed that TPE may be an effective procedure even in critically ill children in accordance with ASFA recommendations. We also showed that mortality rate increased with Pediatric Index of Mortality 3 score at admission and number of organ failures.
(Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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