Use of plasma exchange in pediatric severe sepsis in children's hospitals

Lima, Lisa; Fortenberry, James D.; Hebbar, Kiran

doi:10.1016/j.jcrc.2018.01.028

Cited by 14 publications

(18 citation statements)

References 35 publications

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“…In that study, receiving PE was associated with decreasing mortality over the study period, consistent with an overall decline in mortality secondary to pediatric sepsis over the study period. These results provide prevalence and outcome associations that will help to provide information to prospective studies on benefits of PE in pediatric sepsis . Clinical studies (mostly conducted on adult patients) showed TPE treatment is effective and associated with decreased mortality in sepsis, septic shock, Disseminated intravascular coagulation, and Multiple organ dysfunction syndrome (MODS) .…”

Section: Discussionmentioning

confidence: 88%

“…However, there are a few clinical studies performed showing varying results . In a retrospective multicenter study, plasma exchange was performed in 887 of 49 153 pediatric patients diagnosed with sepsis between 2004 and 2012 and the results were examined . Mortality was higher in sepsis patients who underwent PE treatment; however, a small portion of the patients received PE treatment and they had higher comorbidities, CRRT need, organ failure rate, and PRISM score.…”

Section: Discussionmentioning

confidence: 99%

“…These results provide prevalence and outcome associations that will help to provide information to prospective studies on benefits of PE in pediatric sepsis. 14 Clinical studies (mostly conducted on adult patients) showed TPE treatment is effective and associated with decreased mortality in sepsis, septic shock, Disseminated intravascular coagulation, and Multiple organ dysfunction syndrome (MODS). 12,[15][16][17][18] Recently, TPE was also reported to be beneficial in previously healthy pediatric patients with fulminant sepsisinduced multiorgan failure, if instituted early (within hours) in disease course.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Sepsis continues to be a significant cause of pediatric morbidity and mortality worldwide. Although pediatric mortality from sepsis has steadily decreased in well-resourced settings, in lowand middle-income countries (LMICs) the resources required to support patients with sepsis are scarce and outcomes remain exceptionally poor (1)(2)(3)(4)(5)(6)(7). Coupled with undernutrition, a highly prevalent condition among young children in LMICs, acute infection manifesting initially as diarrhea or pneumonia often progresses to sepsis, and these common infections continue to be primary drivers of death in children less than 5 years old worldwide (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Toll-Like Receptor-Induced Immune Responses During Early Childhood and Their Associations With Clinical Outcomes Following Acute Illness Among Infants in Sub-Saharan Africa

et al. 2022

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Severely ill children in low- and middle-income countries (LMICs) experience high rates of mortality from a broad range of infectious diseases, with the risk of infection-related death compounded by co-existing undernutrition. How undernutrition and acute illness impact immune responses in young children in LMICs remains understudied, and it is unclear what aspects of immunity are compromised in this highly vulnerable population. To address this knowledge gap, we profiled longitudinal whole blood cytokine responses to Toll-like receptor (TLR) ligands among severely ill children (n=63; 2-23 months old) with varied nutritional backgrounds, enrolled in the CHAIN Network cohort from Kampala, Uganda, and Kilifi, Kenya, and compared these responses to similar-aged well children in local communities (n=41). Cytokine responses to ligands for TLR-4 and TLR-7/8, as well as Staphylococcus enterotoxin B (SEB), demonstrated transient impairment in T cell function among acutely ill children, whereas innate cytokine responses were exaggerated during both acute illness and following clinical recovery. Nutritional status was associated with the magnitude of cytokine responses in all stimulated conditions. Among children who died following hospital discharge or required hospital re-admission, exaggerated production of interleukin-7 (IL-7) to all stimulation conditions, as well as leukopenia with reduced lymphocyte and monocyte counts, were observed. Overall, our findings demonstrate exaggerated innate immune responses to pathogen-associated molecules among acutely ill young children that persist during recovery. Heightened innate immune responses to TLR ligands may contribute to chronic systemic inflammation and dysregulated responses to subsequent infectious challenges. Further delineating mechanisms of innate immune dysregulation in this population should be prioritized to identify novel interventions that promote immune homeostasis and improve outcomes.

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“…In a retrospective multicentre study, Lima et al showed that the need for TPE was associated with mortality in PICUs [25]. In this study, 887 patients underwent TPE, and 45% had multi-organ failure.…”

Section: Discussionmentioning

confidence: 71%

Evaluation of Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange, in Severe Sepsis or Septic Shock in Critically Ill Children

et al. 2019

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Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged <18 years who were admitted to two paediatric intensive care units. Demographic data and reason for hospitalization were recorded. In addition, vital signs, haemogram parameters, and biochemistry results were recorded at 0 h and after 24 h of CRRT. Patients were compared according to whether they underwent CRRT or TPE; mortality between the two treatment groups was also compared. Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p < 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE.

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Use of plasma exchange in pediatric severe sepsis in children's hospitals

Cited by 14 publications

References 35 publications

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

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

Toll-Like Receptor-Induced Immune Responses During Early Childhood and Their Associations With Clinical Outcomes Following Acute Illness Among Infants in Sub-Saharan Africa

Evaluation of Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange, in Severe Sepsis or Septic Shock in Critically Ill Children

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