François Mickael, Daubin Delphine, Menouche Dehbia, Gaillet Antoine, Provoost Judith, Trusson Remi, Arrestier Romain, Hequet Olivier, Richard Jean-Christophe, Moranne Olivier, Larcher Romaric, Klouche Kada
Intensive Care Medicine Department, Lapeyronie University Hospital, Montpellier, France.
Department of Apheresis, Henri Mondor Hospital, APHP, Creteil, France.
Crit Care Explor. 2023 Oct 27;5(11):e0988. doi: 10.1097/CCE.0000000000000988. eCollection 2023 Nov.
The aim of this study was to determine, in critically ill patients treated with therapeutic plasma exchange (TPE), the incidence of adverse events as well as the incidence of secondary infections and its predictive factors.
A multicenter retrospective cohort study of an intensive care population treated with TPE to collect adverse events and infectious complications. The characteristics of patients who developed an infection after plasma exchange were compared with those of patients who did not.
Four ICUs of French university hospitals.
All adults admitted between January 1, 2015, and December 31, 2019, who received at least one plasma exchange session were included.
None.
A total of 711 TPE sessions were performed on 124 patients. The most frequent TPE indications were thrombotic microangiopathies ( = 32, 26%), myasthenia gravis ( = 25, 20%), and acute polyradiculoneuropathy ( = 12, 10%). Among the 124 patients, 22 (21%) developed arterial hypotension, 12 (12%) fever, and 9 (9%) electrolyte disturbance during TPE. Moreover, 60 (48%) presented at least one infectious complication: ventilator-associated pneumonia 42, pneumonia 13, bacteremia 18 (of which 6 catheter-related infections) viral reactivation 14. Independent risk factors for ICU-acquired infection were the ICU length of stay (24 vs. 7 d; hazard ratio [HR]: 1.09 [1.04-1.15], < 0.001) and invasive mechanical ventilation (92% vs. 35%; HR: 16.2 [5.0-53.0], < 0.001).
In critically ill patients treated with TPE, adverse events occurring during the procedure remain moderately frequent and are mostly not life-threatening. Infectious complications, mainly ventilation-associated pneumonia, are frequent in this population. The need of mechanical ventilation and longer ICU stay is associated with an increased risk of infection.
本研究旨在确定接受治疗性血浆置换（TPE）的重症患者中不良事件的发生率、继发感染的发生率及其预测因素。
一项对接受TPE治疗的重症监护人群进行的多中心回顾性队列研究，以收集不良事件和感染并发症。比较血浆置换后发生感染的患者与未发生感染的患者的特征。
法国大学医院的四个重症监护病房。
纳入2015年1月1日至2019年12月31日期间入院且接受至少一次血浆置换治疗的所有成年患者。
无。
共对124例患者进行了711次TPE治疗。最常见的TPE适应证是血栓性微血管病（n = 32，26%）、重症肌无力（n = 25，20%）和急性多发性神经根神经病（n = 12，10%）。在124例患者中，22例（21%）在TPE治疗期间出现动脉低血压，12例（12%）发热，9例（9%）出现电解质紊乱。此外，60例（48%）出现至少一种感染并发症：呼吸机相关性肺炎42例、肺炎13例、菌血症18例（其中6例为导管相关感染）、病毒再激活14例。ICU获得性感染的独立危险因素为ICU住院时间（24天 vs. 7天；风险比[HR]：1.09[1.04 - 1.15]，P < 0.001）和有创机械通气（92% vs. 35%；HR：16.2[5.0 - 53.0]，P < 0.001）。
在接受TPE治疗的重症患者中，治疗过程中发生的不良事件仍然较为常见，但大多不危及生命。感染并发症在该人群中很常见，主要是呼吸机相关性肺炎。机械通气需求和更长的ICU住院时间与感染风险增加相关。
