Affiliations 

  • 1 Sarawak General Hospital, Kuching, Malaysia
  • 2 Hospital Tunku Azizah, Malaysia
  • 3 KK Women's and Children's Hospital, Singapore, Singapore
  • 4 Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
  • 5 Birmingham Children's Hospital, Birmingham, UK
  • 6 Pediatric Intensive Care Unit, University Malaya Medical Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 7 Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
J Intensive Care Med, 2023 Jul;38(7):598-611.
PMID: 37097910 DOI: 10.1177/08850666231170775

Abstract

OBJECTIVES: To summarize the role of therapeutic plasma exchange (TPE) in critically ill adults and children with severe sepsis.

DATA COLLECTION: A systematic search was performed using the following databases: Medline, EMBASE, CINAHL, and Cochrane from January 1990 till December 2022. Comparative studies of TPE in severe sepsis were selected. Adult and pediatric data were analyzed separately.

DATA SYNTHESIS: Eight randomized control trials and 6 observational studies (n = 50,142 patients) were included. Centrifugal TPE was the most common modality (209/280, 74.6% adults and 952/1026, 92.7% children). Every TPE study utilized different volume exchanges. Most TPE sessions (1173/1306, 89.8%) employed fresh frozen plasma (FFP) as replacement fluid and heparin as anticoagulant. Adults with severe sepsis supported with TPE using FFP had lower mortality (risk ratio, RR: 0.64 [95% confidence interval, CI: 0.49, 0.84]) compared to those who did not. In contrast, TPE was associated with increased mortality in septic children without thrombocytopenia-associated multiorgan failure (RR: 2.23, 95% CI: 1.93, 2.57). There was no difference in outcomes in patients supported with centrifugal and membrane TPE. In both populations, patients supported on TPE as a continuous regime had poorer outcome.

CONCLUSION: Current evidence indicates that TPE is a potential adjunct therapy in adults with severe sepsis but not in children.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.