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Therapeutic plasma exchange may improve hemodynamics and organ failure among children with sepsis-induced multiple organ dysfunction syndrome receiving extracorporeal life support.

Published on May 1, 2015in Pediatric Critical Care Medicine2.798
· DOI :10.1097/PCC.0000000000000351
Yu Kawai4
Estimated H-index: 4
(UM: University of Michigan),
Timothy T. Cornell20
Estimated H-index: 20
+ 10 AuthorsGail M. Annich22
Estimated H-index: 22
(UM: University of Michigan)
Abstract
Objective To determine the effect of therapeutic plasma exchange (TPE) on hemodynamics, organ failure, and survival in children with multiple organ dysfunction syndrome (MODS) due to sepsis requiring extracorporeal life support (ECLS).
  • References (36)
  • Citations (22)
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References36
Newest
#1Joseph E. Schwartz (Columbia University)H-Index: 94
#2Jeffrey L. Winters (Mayo Clinic)H-Index: 37
Last. Beth H. Shaz (Emory University)H-Index: 29
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#1Giorgio BerlotH-Index: 11
Last. Fabiola GiudiciH-Index: 1
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Aims: To understand how coupled plasma filtration and adsorption (CPFA) could influence the time course of the advanced stages of sepsis, mean arterial pressure (
9 CitationsSource
#1Johannes Hadem (MHH: Hannover Medical School)H-Index: 21
#2Carsten Hafer (MHH: Hannover Medical School)H-Index: 25
Last. Jan T. Kielstein (MHH: Hannover Medical School)H-Index: 47
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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.
21 CitationsSource
#1Nicole De Simone (UTSW: University of Texas Southwestern Medical Center)H-Index: 2
#2Lori Racsa (UTSW: University of Texas Southwestern Medical Center)H-Index: 4
Last. Ravindra Sarode (UTSW: University of Texas Southwestern Medical Center)H-Index: 33
view all 7 authors...
Sepsis with multi organ dysfunction syndrome (MODS) is the most common cause of death in patients in noncoronary intensive care units. Currently, there are no specific treatments that reduce mortality in patients with sepsis and MODS. We report three patients who received therapeutic plasma exchange (TPE) for sepsis with MODS who completely recovered. The first patient, a 3-year-old male presented with Methicillin-resistant Staphylococcus aureus-associated respiratory, renal, coagulation, hepati...
13 CitationsSource
#1Mitchell Dyer (University of Pittsburgh)H-Index: 5
#2Matthew D. Neal (University of Pittsburgh)H-Index: 25
Last. Jay S. Raval (UNC: University of North Carolina at Chapel Hill)H-Index: 16
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Background Extracorporeal membrane oxygenation (ECMO) has been used in patients with pulmonary and/or cardiac disease. In rare circumstances, some patients may have to undergo simultaneous therapeutic plasma exchange (TPE). We sought to characterize simultaneous ECMO and TPE procedures at our institution. Study Design and Methods Retrospective analysis of medical records was performed for patients who underwent simultaneous ECMO and TPE. Patient demographics, diagnoses, TPE indications and varia...
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#1Feihu ZhouH-Index: 6
#2Zhi-Yong PengH-Index: 14
Last. John A. KellumH-Index: 93
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Objectives Although blood purification improves outcomes in animal studies of sepsis, results of clinical trials have been mixed. We conducted a systematic review and meta-analysis of randomized trials to determine the association between various blood purification techniques and all-cause mortality in humans with sepsis.
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Abstract In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S. healthcare problem, accounting for over 720,000 annual hospitalizations. Large-scale epidemiologic studies of severe sepsis continue to be limited, particularly in children. We present data from 1995, 2000, and 2005 in seven U.S. states, examining how case mix, outcome, and resource use for pediatri...
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#1Joseph E. Schwartz (CUMC: Columbia University Medical Center)H-Index: 94
#2Jeffrey L. Winters (MCW: Medical College of Wisconsin)H-Index: 1
Last. Beth H. Shaz (Emory University)H-Index: 29
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#1Brian C. Bridges (Vandy: Vanderbilt University)H-Index: 9
#2Daphne Hardison (Monroe Carell Jr. Children's Hospital at Vanderbilt)H-Index: 5
Last. John B. Pietsch (Vandy: Vanderbilt University)H-Index: 25
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We present three cases of pediatric patients with thrombocytopenia-associated multiple organ failure and the evidence for providing extracorporeal organ support. All three patients had severe cardiac dysfunction, respiratory failure, and acute kidney injury treated with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and plasma exchange. Despite the presence of multiple organ failure and high risk of mortality, all three patients survived with minimal long...
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#1Warwick Butt (University of Melbourne)H-Index: 38
Last. Roberto ChilettiH-Index: 3
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Sepsis and Septic shock in newborns causes mortality and morbidity depending on the organism and primary site. ECMO provides cardiorespiratory support to allow adequate organ perfusion during the time for antibiotics and source control surgery (if needed) to occur. ECMO mode and cannulation site vary depending on support required and local preference. Earlier and more aggressive use of ECMO can improve survival.
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Multiple organ dysfunction syndrome (MODS) is one of the most common syndromes of critical illness and the leading cause of mortality among critically ill patients. Multiple organ dysfunction syndr...
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#1Taylor Sawyer (UW: University of Washington)H-Index: 11
#2Zeenia Billimoria (UW: University of Washington)H-Index: 3
Last. Robert DiGeronimo (UW: University of Washington)H-Index: 18
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Objective To examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE...
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#1Houssam Rebahi (Cadi Ayyad University)H-Index: 3
#2Megan Still (Cadi Ayyad University)H-Index: 2
Last. Ahmed Rhassane El Adib (Cadi Ayyad University)
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Abstract Acute fatty liver of pregnancy (AFLP) continues to raise special concerns since its first post-mortem description by Sheehan in 1940. While early diagnosis and expedite delivery are the cornerstone of management, this condition remains fatal for both mother and fetus. Acute fulminant liver failure is the most serious and life-threatening AFLP-related complication and can require liver transplant despite aggressive supportive management. In lieu of transplant, therapeutic plasma exchange...
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#1Lisa Hensch (BCM: Baylor College of Medicine)H-Index: 1
#2Shiu-Ki Rocky Hui (BCM: Baylor College of Medicine)H-Index: 6
Last. Jun Teruya (BCM: Baylor College of Medicine)H-Index: 16
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Extracorporeal membrane oxygenation (ECMO) is a life-saving procedure that requires careful coagulation management. Indications for ECMO continue to expand, leading to more complicated patients treated by ECMO teams. At our pediatric institution, we utilize a Coagulation Team to guide anticoagulation, transfusion and hemostasis management in an effort to avoid the all-to-common complications of bleeding and thrombosis. This team formulates a coagulation plan in conjunction with a multidisciplina...
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#1Matthew L Friedman (IU: Indiana University)H-Index: 1
#2Michael J. Hobson (IU: Indiana University)H-Index: 1
The use of extracorporeal membrane oxygenation (ECMO) to support children with acute respiratory failure has steadily increased over the past several decades, with major advancements having been made in the care of these children. There are, however, many controversies regarding indications for initiating ECMO in this setting and the appropriate management strategies thereafter. Broad indications for ECMO include hypoxia, hypercarbia, and severe air leak syndrome, with hypoxia being the most com...
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#1Lisa Lima (Emory University)H-Index: 4
#2Courtney McCracken (Emory University)H-Index: 20
Last. Kiran Hebbar (Emory University)H-Index: 13
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Abstract Pediatric severe sepsis (PSS) is an important cause of death in children. Mortality increases in those with sepsis and multiple organ dysfunction syndrome (MODS). Plasma exchange (PE) has been used as an adjuvant therapy in sepsis, with trials demonstrating variable success. This observational retrospective cohort study aimed to characterize patient demographics, PE use, mortality and resource utilization in septic children from 43 children’s hospitals from 2004 to 2012. Of 49,153 PSS c...
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#1Javed Ismail (PGIMER: Post Graduate Institute of Medical Education and Research)H-Index: 1
#2Muralidharan Jayashree (PGIMER: Post Graduate Institute of Medical Education and Research)H-Index: 14
Septic shock in children is associated with high mortality, especially in developing countries. Management includes early recognition, timely antibiotics, aggressive fluid resuscitation, and appropriate vasoactive therapy, to achieve the therapeutic end points. The evidence at each step in management has evolved over the past decade with a paradigm shift in emphasis from a ‘protocolized care’ to an ‘individualized physiology-based care’. This shift mirrors the general trend one observes in criti...
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#1Marguerite Orsi Canter (Vandy: Vanderbilt University)
#2Jessica Daniels (Vandy: Vanderbilt University)
Last. Brian C. Bridges (Vandy: Vanderbilt University)H-Index: 9
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Since the advent of extracorporeal membrane oxygenation (ECMO) over forty years ago, there has been increasing interest in the use of the extracorporeal circuit as a platform for providing multiple organ support. In this review, we will examine the evidence for the use of continuous renal replacement therapy, therapeutic plasma exchange, leukopheresis, adsorptive therapies, and extracorporeal liver support in conjunction with ECMO.
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