Lemaire Aurélie, Parquet Nathalie, Galicier Lionel, Boutboul David, Bertinchamp Rémi, Malphettes Marion, Dumas Guillaume, Mariotte Eric, Peraldi Marie-Noëlle, Souppart Virginie, Schlemmer Benoit, Azoulay Elie, Canet Emmanuel
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.
Therapeutic Apheresis Department, Saint Louis University Hospital, Paris, France.
J Clin Apher. 2017 Dec;32(6):405-412. doi: 10.1002/jca.21529. Epub 2017 Feb 1.
Data on plasma exchange therapy in the intensive care unit (ICU) setting are scarce. We aimed to describe the technical aspects and the adverse events associated with the procedure in critically ill patients.
All adult patients treated by plasma exchange in the medical ICU of the Saint-Louis university hospital between January 1, 2013 and March 31, 2015 were prospectively included.
We report on 260 plasma exchange procedures performed in 50 patients. The centrifugation technique was used for 159 (61%) procedures and the filtration technique for the other 101 (39%) procedures. Both techniques had similar efficacy to treat hyperviscosity syndrome (n = 18). Seventy (26.9%) of the 260 plasma exchange procedures were reported with at least one adverse reaction. Centrifugation and filtration techniques had similar rates of adverse reactions (23.9 vs. 31.7%, P = .19). Hypotension was the most reported (n = 21, 8%) and correlates with a low hematocrit before therapy. Most complications were related to allergic reactions to the replacement fluids. Coagulation disorders depended on the type of replacement fluid. The post-exchange fibrinogen level was decreased by 54% [48;66] with albumin 5%, and 4% [-5;17] with plasma frozen within 24 h. Twenty-three (22.8%) of the 101 filtration procedures experienced filter clotting. Filter clotting was associated with a higher volume exchange prescribed when compared to procedures without filter clotting (4600 [4000;5000] ml vs. 3900 [3600;4800] ml, P < .01).
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.
重症监护病房（ICU）环境下血浆置换治疗的数据稀缺。我们旨在描述该操作在重症患者中的技术要点及相关不良事件。
前瞻性纳入2013年1月1日至2015年3月31日期间在圣路易大学医院内科ICU接受血浆置换治疗的所有成年患者。
我们报告了对50例患者进行的260次血浆置换操作。159次（61%）操作采用离心技术，另外101次（39%）操作采用过滤技术。两种技术在治疗高黏滞综合征（n = 18）方面疗效相似。260次血浆置换操作中有70次（26.9%）报告了至少一种不良反应。离心技术和过滤技术的不良反应发生率相似（23.9%对31.7%，P = 0.19）。低血压是报告最多的不良反应（n = 21，8%），且与治疗前血细胞比容低有关。大多数并发症与对置换液的过敏反应有关。凝血障碍取决于置换液的类型。使用5%白蛋白时，置换后纤维蛋白原水平降低54%[48；66]，使用24小时内冷冻的血浆时降低4%[-5；17]。101次过滤操作中有23次（22.8%）出现滤器凝血。与未出现滤器凝血的操作相比，出现滤器凝血的操作规定的置换量更大（4600[4000；5000]ml对3900[3600；4800]ml，P < 0.01）。
在ICU环境下，血浆置换是一种相对安全且一般耐受性良好的操作。大多数不良事件不可预测，且与轻微过敏反应有关。
