Therapeutic Plasma Exchange in Pediatric Intensive Care and Brief Overview of the Literature

Abstract

Objectives: This study aimed to evaluate the therapeutic plasma exchange (TPE) procedures performed in our pediatric intensive care unit (PICU) and to review the relevant literature. Methods: This retrospective study was conducted between 2020 and 2024. Forty-nine patients who received TPE at any point during their PICU stay were included. The groups were categorized as survivors and non-survivors. Results: Of the 49 cases, 71.4% were male, with a median age of 54 months (range 20-135 months). A total of 274 TPE sessions were performed. The three most common indications for TPE were sepsis, trauma induced multiple organ dysfunction syndrome/ disseminated intravascular coagulation, and neurological diseases. The non-survivor group had higher rates of chronic illness (p<0.001), pediatric risk of mortality score III, and pre-and post-procedure vasoactive inotropic scores (p=0.005, p<0.001, and p<0.001, respectively). The use of invasive mechanical ventilation and continuous renal replacement therapy (p=0.005, p<0.001, respectively), as well as TPE in cases with sepsis (p<0.001), were more frequent in non-survivors. The most common complication during the procedures was hypotension (9.9%). Conclusion: Sepsis remains the most frequent indication for TPE in PICUs. Although the most common complication of TPE in our study was hypotension, there were no life-threatening complications, suggesting it is a safe treatment modality.