Therapeutic plasma exchange in critically ill children: experience of the pediatric intensive care unit of two centers in Chile.
Transfus Apher Sci
; 60(5): 103181, 2021 Oct.
Article
em En
| MEDLINE
| ID: mdl-34238709
ABSTRACT
INTRODUCTION:
Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort.METHODS:
A retrospective observational study in two pediatric intensive care units in Chile during eight years (2011-2019)Results:
A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane-based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58 % of children received other immunomodulatory therapy. According to ASFA, 45 % of cases were I-II category, 50 % to III, and 5% not classified. Response to treatment was complete in 64 % (23/36) and partial in 33 % (12/36). Complications occurred in 17.4 % of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92 %. Patients who received TPE as a single therapy (n = 26) survived 96 %. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p = 0.004).CONCLUSIONS:
TPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment. Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Troca Plasmática
/
Unidades de Terapia Intensiva Pediátrica
/
Cuidados Críticos
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article