Therapeutic plasma exchange in pediatric intensive care: Indications, results and complications

Abstract

Therapeutic plasma exchange (TPE) is an effective treatment method in selective indications. Secondary to access and technical features, it is more difficult to apply in pediatric population than adults. The aim of this study is investigate safety, clinical indications, and results of this method in critically ill pediatric patients who need TPE treatment. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 4 years (2015–2019) were evaluated retrospectively. TPE procedures (635) were performed for 135 patients. Median age was 34 months (10‐108). Ninety‐seven patients had mechanical ventilation support. Sepsis with multiple organ failure was the most frequent indication and accounted for 44.4% (n = 60) of the indications followed by hematological and neurological diseases (19.2% and 9.6% respectively). TPE was performed alone in 469 cases (73.9%), in combination with continuous renal replacement therapy in 154 cases (24.2%), and additional to extracorporeal membrane oxygenation in 12 cases (1.9%). Hematological disease and sepsis subgroups had the highest intubation rate, mechanical ventilation period, PRISM score, organ failure count, and mortality. Fresh frozen plasma (FFP) was the most frequently used replacement fluid in 90.4% of the procedures. The most frequent anticoagulant used in TPE was acid citrate dextrose solution (79.3%). Procedural complications were detected in 104 cases (16.3%) and occurred during TPE sessions. Overall survival rate was 78.5%. We found that the non‐survivor group had significantly higher rates of organ failures (P = 0.0001), higher PRISM scores on admission (P = 0.0001), and higher rates of invasive ventilation support needed (P = 0.012). TPE is a treatment method which can be safely provided in healthcare facilities with necessary medical and technical requirements. Although it is riskier to provide such treatment to critically ill children, complications can be minimized in experienced healthcare facilities. Overall results are good and can vary depending on indication.

Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience

“… 7 The World Apheresis Registry found that neurological disorders were most commonly treated. 8 Similar to our study, Sık et al, 9 in a single-center study, reported that sepsis with multi-organ dysfunction syndrome (MODS) (44.4%) was the most frequent indication for TPE. This is because both studies were conducted in PICUs.…”

“… 15 Şık et al showed that the sepsis survival rate was 75% in critically ill pediatric patients. 9 Our rate was 71.4%; five of seven patients who underwent TPE because of sepsis-related MODS survived.…”

Therapeutic plasma exchange for life‐threatening pediatric disorders

“…13 The incidence of AEs in children receiving TPE ranges from 2.2% to 82%. [14][15][16][17][18] These variations are partly linked to a difference in the data collection process and reflect fundamental differences in AE frequency. Citrate intolerance, reactions to plasma, kit problems, and venous access complications have often been reported for children and adults.…”

“…The first TPE series of sessions covered 549 of the 731 procedures. Each patient underwent a median of 6 procedures [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], with a median volume of 1834 mL [500-5000 mL]; this corresponded to a median total plasma volume equivalent of 1.4 L/m 2 [0.6-2.1 L/m 2 ] (Table 2). The first procedures were performed with peripheral vascular access in only six cases (8%).…”

Safety of Therapeutic Apheresis in Children and Adolescents

“…The basic principle of PE is the elimination of pathogenic molecules, by replacing the patient’s plasma by foreign plasma or human albumin solution ( 4 ). Another option is IA, in which specially coated columns are used to adsorb antibodies from the patient’s blood ( 5 ).…”