Paton Emily, Baldwin Ian C
Department of Intensive Care, Austin Health, 145 Studley Rd, Heidelberg, Melbourne 3084, Australia.
Aust Crit Care. 2014 Aug;27(3):139-44. doi: 10.1016/j.aucc.2013.10.001. Epub 2013 Nov 17.
Plasma exchange (PE) is a therapeutic technique for the removal of illness-associated antibodies and toxins. Little is currently known about the prescription and technique for PE in the Intensive Care setting. In addition, different illnesses require specific PE regimens to optimise the clinical outcome for the patient. We sought to audit our use of PE for: number of treatments, clinical indications, treatments prescribed and administered, any procedural or patient complications, and adherence to current best practice recommendations.
A retrospective audit involving all patients who were admitted to our tertiary 20 bed Intensive Care Unit (ICU) and received PE therapy between 1 January 2002 and 31 December 2011. Data was collected from identified patient medical records using a specifically designed case report form.
Thirty unique patients were identified in this audit. There was an incidence of 0.15% use of PE during this period. Eighteen female patients (60%) were indentified, median age 59.5 (48-70) years. These 30 patients were prescribed 135 PE treatments, requiring 156 membranes in total with a 15.5% incidence of premature circuit clotting. Thrombotic Thrombocytopenic Purpura (TTP) was the most common indication for PE (37%) with 10 other clinical indications. Median length of ICU admission was 9.5 (3-17) days. The PE regimens received by patients in this ICU were not always prescribed in accordance with current best practice recommendations. No patient complications were identified with these PE treatments.
PE is a valuable treatment option for critically ill patients suffering antibody-mediated illness. The findings of this audit have identified differences between the current prescription recommendations for PE and those applied. TTP was the most common indication for PE, and no patient complications were identified, however a 15.5% incidence of circuit clotting occurred. The infrequency of the therapy and the different indications present a challenge for Intensive Care clinicians to provide best care in all cases. Improving the prescription of PE through the implementation of a new protocol and clinical education may result in better outcomes for our patients.
血浆置换（PE）是一种用于清除与疾病相关的抗体和毒素的治疗技术。目前对于重症监护环境下血浆置换的处方和技术了解甚少。此外，不同疾病需要特定的血浆置换方案以优化患者的临床结局。我们试图审核我们在以下方面对血浆置换的使用情况：治疗次数、临床指征、所开处方及实施的治疗、任何操作或患者并发症，以及对当前最佳实践建议的遵循情况。
一项回顾性审核，涉及所有于2002年1月1日至2011年12月31日期间入住我们拥有20张床位的三级重症监护病房（ICU）并接受血浆置换治疗的患者。使用专门设计的病例报告表从已识别的患者病历中收集数据。
本次审核共识别出30例不同患者。在此期间血浆置换的使用率为0.15%。识别出18例女性患者（60%），中位年龄59.5（48 - 70）岁。这30例患者共接受了135次血浆置换治疗，总共需要156个滤器，早期体外循环凝血发生率为15.5%。血栓性血小板减少性紫癜（TTP）是血浆置换最常见的指征（37%），还有其他10种临床指征。ICU住院时间的中位数为9.5（3 - 17）天。该ICU患者接受的血浆置换方案并非总是按照当前最佳实践建议开具。这些血浆置换治疗未发现患者并发症。
血浆置换是患有抗体介导疾病的重症患者的一种有价值的治疗选择。本次审核结果显示了当前血浆置换处方建议与实际应用之间的差异。TTP是血浆置换最常见的指征，未发现患者并发症，然而体外循环凝血发生率为15.5%。该治疗方法使用频率低且指征各异，这给重症监护临床医生在所有病例中提供最佳治疗带来了挑战。通过实施新方案和临床教育来改进血浆置换的处方，可能会为我们的患者带来更好的结局。
