Raul Bustos B1, Lilian Hickmann O2, Pablo Cruces R3, Franco Díaz4. 1. Unidad de Cuidado Intensivo Pediátrico, Clínica Sanatorio Alemán y Hospital Guillermo Grant Benavente, Concepción, Chile. Electronic address: rbustos@sanatatorioaleman.cl. 2. Unidad de Cuidado Intensivo Pediátrico, Hospital Guillermo Grant Benavente, Concepción, Chile. Electronic address: lilihickmann@gmail.com. 3. Unidad de Paciente Crítico Pediatrico, Hospital El Carmen, Maipú, Chile; Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile. Electronic address: pcrucesr@gmail.com. 4. Unidad de Paciente Crítico Pediatrico, Hospital El Carmen, Maipú, Chile; Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile. Electronic address: francodiazr@gmail.com.
Abstract
INTRODUCTION: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort. METHODS: A retrospective observational study in two pediatric intensive care units in Chile during eight years (2011-2019) Results: A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane-based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58 % of children received other immunomodulatory therapy. According to ASFA, 45 % of cases were I-II category, 50 % to III, and 5% not classified. Response to treatment was complete in 64 % (23/36) and partial in 33 % (12/36). Complications occurred in 17.4 % of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92 %. Patients who received TPE as a single therapy (n = 26) survived 96 %. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p = 0.004). CONCLUSIONS: TPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment. Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.
INTRODUCTION: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort. METHODS: A retrospective observational study in two pediatric intensive care units in Chile during eight years (2011-2019) Results: A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane-based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58 % of children received other immunomodulatory therapy. According to ASFA, 45 % of cases were I-II category, 50 % to III, and 5% not classified. Response to treatment was complete in 64 % (23/36) and partial in 33 % (12/36). Complications occurred in 17.4 % of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92 %. Patients who received TPE as a single therapy (n = 26) survived 96 %. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p = 0.004). CONCLUSIONS: TPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment. Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.
Authors: Christina Taylan; Anne Schaaf; Corina Dorn; Claus Peter Schmitt; Sebastian Loos; Nele Kanzelmeyer; Lars Pape; Dominik Müller; Lutz T Weber; Julia Thumfart Journal: Front Pediatr Date: 2022-04-12 Impact factor: 3.418