Sık Guntulu, Demirbuga Asuman, Annayev Agageldi, Akcay Arzu, Çıtak Agop, Öztürk Gülyüz
Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Pediatric Intensive Care, Istanbul, Turkey.
Acıbadem Mehmet Ali Aydınlar University, Pediatric Bone Marrow Transplantation Uni, Istanbul, Turkey.
Ther Apher Dial. 2020 Apr;24(2):221-229. doi: 10.1111/1744-9987.13474. Epub 2020 Feb 17.
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.
治疗性血浆置换（TPE）在特定适应症中是一种有效的治疗方法。由于通路和技术特点，在儿科人群中应用比在成人中更困难。本研究的目的是调查这种方法在需要TPE治疗的危重症儿科患者中的安全性、临床适应症和结果。回顾性评估了在一家提供三级护理的儿科重症监护病房4年（2015 - 2019年）期间进行的所有TPE程序。为135例患者进行了635次TPE程序。中位年龄为34个月（10 - 108个月）。97例患者有机械通气支持。脓毒症伴多器官功能衰竭是最常见的适应症，占适应症的44.4%（n = 60），其次是血液学和神经学疾病（分别为19.2%和9.6%）。469例（73.9%）单独进行TPE，154例（24.2%）与连续性肾脏替代治疗联合进行，12例（1.9%）在体外膜肺氧合基础上进行。血液学疾病和脓毒症亚组的插管率、机械通气时间、PRISM评分、器官功能衰竭计数和死亡率最高。在90.4%的程序中，新鲜冰冻血浆（FFP）是最常用的置换液。TPE中最常用的抗凝剂是枸橼酸葡萄糖酸溶液（79.3%）。在104例（16.3%）中检测到操作并发症，且发生在TPE过程中。总体生存率为78.5%。我们发现非存活组的器官功能衰竭发生率显著更高（P = 0.0001），入院时PRISM评分更高（P = 0.0001），需要有创通气支持的发生率更高（P = 0.012）。TPE是一种可以在具备必要医疗和技术条件的医疗机构安全提供的治疗方法。虽然对危重症儿童提供这种治疗风险更高，但在经验丰富的医疗机构中并发症可以降至最低。总体结果良好，且可能因适应症而异。
