Survival Benefits of Therapeutic Plasma Exchange in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis.
J Intensive Care Med
; 38(7): 598-611, 2023 Jul.
Article
em En
| MEDLINE
| ID: mdl-37097910
ABSTRACT
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. DATASYNTHESIS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
/
Sepse
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Systematic_reviews
Limite:
Adult
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Child
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Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article