Evaluation of patients undergoing therapeutic plasma exchange in the pediatric intensive care unit and determining the factors affecting prognosis.

Abstract

Introduction: Therapeutic plasma exchange (TPE), an extracorporeal method targeting the removal of large molecular weight pathogens, is explored in this study for indications, complications, prognosis, safety, and effectiveness.

Methods: The patients' data were collected retrospectively.

Results: Overall, 334 sessions of TPE were applied to 57 patients. Per the American Society for Apheresis classification, 24.6% of indications fell under Category I, 14% Category II, and 50.9% Category III. Sepsis-induced multiorgan dysfunction syndrome (MODS) emerged as the leading indication, correlating with elevated needs for mechanical ventilation (MV), increased failed organs, and heightened mortality. Patients undergoing continuous renal replacement therapy faced a 16.06 times higher mortality risk. Non-survivors exhibited higher comorbidity, prolonged MV, increased inotropic drug requirement, more failed organs, and a higher PRISM score. 33.2% of complications occurred, primarily catheter-related.

Conclusion: Sepsis-induced MODS and extracorporeal modalities are associated with increased mortality in TPE patients, with comorbidities, ventilation, and PRISM scores potentially influencing outcomes.