Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients.

BACKGROUND: Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics & outcome. METHODS: We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 × plasma volume. RESULTS: In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p < 0.002) and norepinephrine dose which significantly reduced post TPE (p < 0.001). In addition, norepinephrine dose to mean arterial pressure significantly improved (p < 0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p < 0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p < 0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p < 0.01). C-reactive protein significantly improved after TPE (P < 0.01). CONCLUSION: Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.

Relationship of epicardial fat thickness with endothelial and cardiac functions in children with family history of type 2 diabetes mellitus.

OBJECTIVE: We hypothesized that many of the pathophysiological mechanisms that cause atherosclerotic disease may be present in early childhood in children with family history of type 2 diabetes. We aimed to investigate the relation of epicardial fat thickness (EFT) with flow-mediated dilatation (FMD) and diastolic function in children with family history of type 2 diabetes mellitus. METHODS: We measured EFT, FMD, in 209 children (mean age 8.6 + 3.2 years). Children were classified into 2 groups: 109 children with a family history of type 2 diabetes (group at risk) and 100 healthy children with age and body mass index matched and without parental history of diabetes constituted the control group. RESULTS: Epicardial fat thickness was significantly increased in group at risk compared with control children (P < 0.001), while FMD was significantly lower in group at risk versus controls (P < 0.001). EFT was inversely correlated with FMD (r = -0.46; P < 0.001), while it was positively correlated with E/E' (r = 0.48; P < 0.001) and hsCRP (r = 0.39; P < 0.001). Receiver-operating characteristic curve analysis revealed a cutoff value of 5 mm for EFT can predict endothelial dysfunction in children with family history of DM area under the curve (AUC = 0.852) with a specificity of 92.2% and a sensitivity of 77.4%. CONCLUSION: Our results suggest that children with family history of type 2 diabetes bear considerably impaired FMD% and diastolic dysfunction associated with increased EFT, that reflecting process that promote the development of cardiovascular disease (CVD).