Single plasma exchange in six pediatric patients with severe septic shock

Despite advances in the management of severe sepsis, the mortality rate of septic shock in children and adults remains high. Meningococcal disease is the leading cause of sepsis affecting previously healthy children and young adults. In a septic infection, the production and release of mediators of inflammation may lead to severe organ damage. The use of plasma exchange is intended to reduce the level of inflammatory mediators as an adjunctive therapy accompanying the standard medical care. We retrospectively studied six patients (median age 6.5 years, range 0.8-16 years) suffering from primary septic shock (4/6 with a proven meningococcal disease) who were treated with a single plasma exchange. The inclusion criteria for plasma exchange were clinical impression of a septic shock showing typical skin lesions and a refractory hypotension after volume therapy. The plasma exchange was conducted once between 3 and 8 hours after admission for a period of 1-3.3 hours. The Pediatric Risk of Mortality (PRISM-I) score ranged from 10 to 36. The mortality rate was 33%, but all of the four patients suffering from meningococcal sepsis survived. Neither circulatory conditions nor oxygenation showed relevant improvement during plasma exchange or in the two hours afterwards. All patients with proven meningococcal sepsis survived, but based on the limited number of patients in this study further conclusions can not be drawn. From the clinical and pathophysiological studies available so far, there is insufficient evidence to justify the use of plasma exchange as standard treatment in primary septic shock in children.