Duyu Muhterem, Turkozkan Ceren
Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul, Turkey.
Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey.
Transfus Apher Sci. 2020 Oct;59(5):102959. doi: 10.1016/j.transci.2020.102959. Epub 2020 Sep 24.
The objective of this study is to characterize clinical indications, safety and outcome with the use of TPE in critically ill children. All TPE procedures performed in a tertiary pediatric intensive care unit (PICU) during a 5-year period were retrospectively evaluated. A total of 75 patients underwent 249 sessions of TPE. Sepsis-induced multiple organ dysfunction syndrome (MODS) was the most common indication with 29.3 %. American Society for Apheresis classifications were as follows: Category I: 24 %, Category II: 16 %, Category III: 45.3 % and Category IV: 4%, while 10.7 % of the patients could not be classified. TPE was performed without any adjunct procedures in 188 sessions (75.5 %), while it was combined with continuous renal replacement therapy (CRRT) in 49 sessions (19.7 %) and with CRRT and extracorporeal membrane oxygenation (ECMO) in 12 (4.8 %) sessions. Overall survival rate was 73.3 %. The survival rate in patients requiring only TPE was 86.5 %, while the survival rates of patients who had CRRT and ECMO were 45 % and 33.3 %, respectively. Complications associated with the procedure occurred in 48 (19.2 %) TPE sessions. The lowest survival rate (31.9 %) was in patients with sepsis-induced MODS. Finally, we also found significantly higher organ failure rate, mechanical ventilation requirement, and PRISM III score at PICU admission in non-survivors. Our experience indicates that TPE can be performed relatively safely in critically ill children with appropriate treatment indications. Survival rate may vary depending on the underlying disease; however, it must be noted that survival rate is very high in children requiring TPE only.
本研究的目的是描述在危重症儿童中使用治疗性血浆置换（TPE）的临床指征、安全性和结局。对一家三级儿科重症监护病房（PICU）在5年期间进行的所有TPE程序进行回顾性评估。共有75例患者接受了249次TPE治疗。脓毒症诱发的多器官功能障碍综合征（MODS）是最常见的指征，占29.3%。美国血液分离协会的分类如下：I类：24%，II类：16%，III类：45.3%，IV类：4%，而10.7%的患者无法分类。188次治疗（75.5%）在没有任何辅助程序的情况下进行TPE，49次治疗（19.7%）将其与持续肾脏替代治疗（CRRT）联合，12次治疗（4.8%）将其与CRRT和体外膜肺氧合（ECMO）联合。总生存率为73.3%。仅需要TPE的患者生存率为86.5%，而接受CRRT和ECMO的患者生存率分别为45%和33.3%。48次（19.2%）TPE治疗出现与该程序相关的并发症。脓毒症诱发MODS的患者生存率最低（31.9%）。最后，我们还发现非幸存者在PICU入院时器官衰竭率、机械通气需求和PRISM III评分显著更高。我们的经验表明，在有适当治疗指征的危重症儿童中，TPE可以相对安全地进行。生存率可能因基础疾病而异；然而，必须注意的是，仅需要TPE的儿童生存率非常高。
