Plasma exchange in the intensive care unit: Technical aspects and complications

Lemaire, Aurélie; Parquet, Nathalie; Galicier, Lionel; Boutboul, David; Bertinchamp, Rémi; Malphettes, Marion; Dumas, Guillaume; Mariotte, Éric; Péraldi, Marie-Noëlle; Souppart, Virginie; Schlemmer, Benoı̂t; Azoulay, Élie; Canet, Emmanuel

doi:10.1002/jca.21529

Cited by 57 publications

(72 citation statements)

References 25 publications

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“…Almost all patients in our study were treated with immunosuppressors combined with plasmapheresis (70%). Other ICU studies showed similar percentages of adjuvant immunosuppressive drugs use (76%--82%) 8,11,13 . The most used immunosuppressants were steroids, intravenous immunoglobulin, mycophenolate mofetil and azathioprine.…”

Section: Complications and Therapy Outcomesmentioning

confidence: 59%

“…In 60% it was necessary to start at least one organ support (mechanical ventilation -50%, RRT -37.5% or vasopressor therapy -12.5%) which is in accordance with a Spanish study of 24 ICU patients submitted to plasmapheresis where 62.5% needed organ support 14 . In contrast, Lemaire et al 8 and Benítez et al 14 showed a different incidence of organ support with 14 -27.8% patients requiring vasopressor therapy, 22 -31.6% mechanical ventilation, and 24 -26.3% patients requiring RRT. These differences are probably related to the underlying diseases, since our study included more patients with myasthenia gravis (5 vs. none 8,13 ) which may explain the higher need of mechanical ventilation.…”

Section: Complications and Therapy Outcomesmentioning

confidence: 92%

“…TPE is a generally safe and well -tolerated technique but adverse events exist 1 and they are a particular concern in the critical care setting, where the margin of error is very narrow. Critically ill patients are more likely to experience hemodynamic instability, coagulation disorders or electrolyte disturbances that may hamper the efficacy of the technique 8 . The reported complication rate is 4 -25% 2 and the incidence of complications depends on the anticoagulation and replacement fluid used, volume exchanged, vascular access, plasma separation method and underlying disease 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Severe complications are usually caused by anaphylactic reactions to the replacement fluid and are most common with FFP 1,2 . The rate of complications appears to be similar in patients admitted to the Intensive Care Unit (ICU), although data is much scarcer 8,11 .…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic plasma exchange in patients in a portuguese ICU

Calça¹,

Gaspar²,

Santos³

et al. 2020

pjnh

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Purpose: The aim of this study is to characterize a Portuguese Intensive Care Unit experience in therapeutic plasma exchange in critically ill patients. Methods: We performed a retrospective analysis of the patients treated with therapeutic plasma exchange between 2000 and 2019. Data on patient characteristics, therapeutic plasma exchange prescription, adjuvant therapy used, adverse events and outcome under treatment were collected. Results: A total of 101 therapeutic plasma exchange procedures in 20 patients were studied. Mean number of therapeutic plasma exchange sessions per patient was 5.1±1.3. The most frequent indications to begin this treatment were myasthenia gravis (25.0%) and anti-neutrophil-cytoplasmic antibody-associated vasculitis (15.0%). There were 45.5% adverse events and the most frequent was hypotension (15.2%). 98% of the complications were mild-to-moderate. The outcome was favorable in 60.0% of patients. Conclusion: Therapeutic plasma exchange is an effective and safe therapy in many diseases that had high morbidity and mortality prior to the use of this technique.

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Section: Complications and Therapy Outcomesmentioning

confidence: 59%

Section: Complications and Therapy Outcomesmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Therapeutic plasma exchange in patients in a portuguese ICU

Calça¹,

Gaspar²,

Santos³

et al. 2020

pjnh

View full text Add to dashboard Cite

show abstract

“…Close hemodynamic monitoring and frequent evaluation of new symptoms (ie, shortness of breath, lightheadedness) in an intensive care setting are recommended. One of the most significant studies on TPE in the intensive care unit evaluated 260 TPE procedures performed in 50 patients, and the researchers reported that around 1.1% of cases developed life‐threatening complications and 26.9% exhibited non–life‐threatening complications …”

Section: Cases and Discussionmentioning

confidence: 99%

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

Joury

Alshehri

Mahendra

et al. 2019

J of Clinical Apheresis

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Hypertriglyceridemia-induced acute pancreatitis (HGAP) is the third most common etiology of acute pancreatitis. HGAP can be attributed to genetic disturbances in triglyceride metabolism or multiple secondary causes. Here, we presented three cases for HGAP and explored different therapeutic approaches for treating HGAP. A case series of three patients who presented with HGAP and underwent different therapeutic approaches was conducted. The first patient was a 37-year-old male who presented with nonsevere HGAP; he was treated with conservative therapy with insulin and heparin infusion, which resulted in clinical and laboratory improvement. The second patient was a 64-year-old male with human immunodeficiency virus on multiple highly active antiretroviral therapy. He presented with severe HGAP and multiorgan failure. After initiation of therapeutic plasma exchange, his HGAP resolved. The third patient was a 28-year-old male who presented with recurrent episodes of HGAP; his conservative therapy failed and was eventually escalated to therapeutic plasma exchange (TPE). HGAP can be attributed to genetic disturbances of lipid or secondary etiologies. A nonsevere form of HGAP can be managed with conventional therapy including insulin and heparin; however, severe HGAP may require TPE. K E Y W O R D S hypertriglyceridemia, pancreatitis, therapeutic plasma exchange

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Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria

et al. 2019

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IMPORTANCE Spinal cord infarction (SCI) is often disabling, and the diagnosis can be challenging without an inciting event (eg, aortic surgery). Patients with a spontaneous SCI are often misdiagnosed as having transverse myelitis. Diagnostic criteria for SCI are lacking, hindering clinical care and research. OBJECTIVE To describe the characteristics of spontaneous SCI and propose diagnostic criteria. DESIGN, SETTING, AND PARTICIPANTS An institution-based search tool was used to identify patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1997 to December 2017 with a spontaneous SCI. Patients provided written consent to use their records for research. Participants were 18 years and older with a diagnosis of spontaneous SCI (n = 133), and controls were selected from a database of alternative myelopathy etiologies for validation of the proposed diagnostic criteria (n = 280). MAIN OUTCOMES AND MEASURES A descriptive analysis of SCI was performed and used to propose diagnostic criteria, and the criteria were validated. RESULTS Of 133 included patients with a spontaneous SCI, the median (interquartile range) age at presentation was 60 (52-69) years, and 101 (76%) had vascular risk factors. Rapid onset of severe deficits reaching nadir within 12 hours was typical (102 [77%]); some had a stuttering decline (31 [23%]). Sensory loss occurred in 126 patients (95%), selectively affecting pain/temperature in 49 (39%). Initial magnetic resonance imaging (MRI) spine results were normal in 30 patients (24%). Characteristic MRI T2-hyperintense patterns included owl eyes (82 [65%]) and pencil-like hyperintensity (50 [40%]); gadolinium enhancement (37 of 96 [39%]) was often linear and located in the anterior gray matter. Confirmatory MRI findings included diffusion-weighted imaging/apparent diffusion coefficient restriction (19 of 29 [67%]), adjacent dissection/occlusion (16 of 82 [20%]), and vertebral body infarction (11 [9%]). Cerebrospinal fluid showed mild inflammation in 7 of 89 patients (8%). Diagnostic criteria was proposed for definite, probable, and possible SCI of periprocedural and spontaneous onset. In the validation cohort (n = 280), 9 patients (3%) met criteria for possible SCI, and none met criteria for probable SCI. CONCLUSIONS AND RELEVANCE This large series of spontaneous SCIs provides clinical, laboratory, and MRI clues to SCI diagnosis. The diagnostic criteria proposed here will aid clinicians in making the correct diagnosis and ideally improve future care for patients with SCI. The validation of these criteria supports their utility in the evaluation of acute myelopathy.

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Plasma exchange in the intensive care unit: Technical aspects and complications

Abstract: Plasma exchange is a relatively safe and generally well-tolerated procedure in the ICU setting. Most adverse events are unpredictable and related to minor allergic reactions.

Cited by 57 publications

References 25 publications

Therapeutic plasma exchange in patients in a portuguese ICU

Therapeutic plasma exchange in patients in a portuguese ICU

Therapeutic approaches in hypertriglyceridemia‐induced acute pancreatitis: A literature review of available therapies and case series

Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria

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