David Sascha, Russell Lene, Castro Pedro, van de Louw Andry, Zafrani Lara, Pirani Tasneem, Nielsen Nathan D, Mariotte Eric, Ferreyro Bruno L, Kielstein Jan T, Montini Luca, Brignier Anne C, Kochanek Matthias, Cid Joan, Robba Chiara, Martin-Loeches Ignacio, Ostermann Marlies, Juffermans Nicole P
Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
Intensive Care Med Exp. 2023 May 8;11(1):26. doi: 10.1186/s40635-023-00510-w.
Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to "TPE in the critically ill patient". These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk-benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.
治疗性血浆置换（TPE）是一种治疗干预措施，它将血浆与血细胞分离，以去除病理因素或补充缺乏的因素。在过去几十年中，TPE的使用正在增加。然而，尽管TPE作为治疗多种与危重病相关的疾病或综合征具有良好的理论依据和生物学合理性，但在重症监护病房（ICU）环境中，TPE尚未得到广泛研究。来自全球不同临床背景的18位专家组成的小组使用改良的德尔菲法提出了与“危重病患者的TPE”相关的关键研究问题。这些问题集中在：（1）去除和置换过程的病理生理作用，（2）最佳治疗时机，（3）剂量和治疗方案，（4）风险效益假设，以及（5）需要探索的新适应症。针对所有五个主题，评估了当前的理解以及知识空白和未来方向。该内容应激发该领域的未来研究和新的临床应用。
