Survival Benefits of Therapeutic Plasma Exchane in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis

被引:18
作者
Lee, Olive P. E. [1 ,2 ]
Kanesan, Nalaayeni [3 ]
Leow, Esther H. [4 ]
Sultana, Rehena [5 ]
Chor, Yek K. [2 ]
Gan, Chin S. [6 ]
Lee, Jan H. [7 ,8 ]
机构
[1] Sarawak Gen Hosp, Kuching, Malaysia
[2] Birmingham Childrens Hosp, Birmingham, England
[3] Hosp Tunku Azizah, Kuala Lumpur, Malaysia
[4] KK Womens & Childrens Hosp, Singapore, Singapore
[5] Duke NUS Med Sch, Ctr Quantitat Med, Singapore, Singapore
[6] Univ Malaya, Med Ctr, Fac Med, Pediat Intens Care Unit, Kuala Lumpur, Malaysia
[7] KK Womens & Childrens Hosp, Childrens Intens Care Unit, Singapore, Singapore
[8] Duke NUS Med Sch, SingHlth Duke NUS Paediat Acad Clin Programme, Singapore, Singapore
关键词
sepsis; septic shock; therapeutic plasma exchange; plasmapheresis; plasma filtration; plasma exchange; mortality; MULTIPLE ORGAN FAILURE; WRITING COMMITTEE; AMERICAN SOCIETY; GUIDELINES; EPIDEMIOLOGY; APHERESIS; CHILDREN;
D O I
10.1177/08850666231170775
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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.
引用
收藏
页码:598 / 611
页数:14
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