Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patients

BMC Anesthesiology

Johannes Hadem²  Carsten Hafer³  Andrea S Schneider²  Olaf Wiesner⁴  Gernot Beutel¹  Thomas Fuehner⁴  Tobias Welte⁴  Marius M Hoeper⁴  Jan T Kielstein³ 

[1] Department of Hematology, Hemostasis, Oncology, and Stem-Cell Transplantation, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany

[2] Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany

[3] Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Strasse 1, D- 30625 Hannover, Germany

[4] Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany

关键词: Streptococcal toxic shock syndrome;    Plasmapheresis;    Apheresis;    Multiple organ failure;    Multiorgan dysfunction syndrome;   

Others  :  816428
DOI  :  10.1186/1471-2253-14-24

 received in 2013-03-06, accepted in 2014-03-31,  发布年份 2014

【 摘 要 】

Background

Several case series and small randomized controlled trials suggest that therapeutic plasma exchange (TPE) improves coagulation, hemodynamics and possibly survival in severe sepsis. However, the exact role of TPE in modern sepsis therapy remains unclear.

Methods

We performed a retrospective observational single-centre study on the use of TPE as rescue therapy in 23 consecutive patients with severe sepsis or septic shock from 2005 to 2012. Main surrogate markers of multiple organ failure (MOF) before, during and after TPE as well as survival rates are reported.

Results

At baseline, mean SOFA score was 13 (standard deviation [SD] 4) and median number of failed organ-systems was 5 (interquartile range [IQR] 4–5). TPEs were performed 3 days (IQR 2–10) after symptom onset and 1 day (IQR 0–8) after ICU admission. The median total exchange volume was 3750 ml (IQR 2500–6000), which corresponded to a mean of 1.5 times (SD 0.9) the individual plasma volume. Fresh frozen plasma was used in all but one treatments as replacement fluid. Net fluid balance decreased significantly within 12 hrs following the first TPE procedure by a median of 720 mL (p = 0.002), irrespective of outcome. Reductions of norepinephrine dose and improvement in cardiac index were observed in individual survivors, but this was not significant for the overall cohort (p = 0.574). Platelet counts decreased irrespective of outcome between days 0 and 2 (p < 0.003), and increased thereafter in many survivors. There was a non-significant trend towards younger age and higher procalcitonin levels among survivors. Nine out of 23 TPE treated patients (39%) survived until ICU discharge (among them 3 patients with baseline SOFA scores of 15, 17, and 20).

Conclusions

Our data suggest that some patients with severe sepsis and septic shock may experience hemodynamic stabilisation by early TPE therapy.

【 授权许可】

   
2014 Hadem et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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Figure 3.

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