Therapeutic Plasma Exchange in Neonatal Septic Shock: A Retrospective Cohort Study

2019 ◽  
Vol 37 (09) ◽  
pp. 962-969
Author(s):  
Taylor Sawyer ◽  
Zeenia Billimoria ◽  
Sarah Handley ◽  
Kendra Smith ◽  
Larissa Yalon ◽  
...  

Objective This study aimed 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 was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xing-Ran Zhai ◽  
Jing-Jing Tong ◽  
Hong-Min Wang ◽  
Xiang Xu ◽  
Xiu-Ying Mu ◽  
...  

Abstract Background Infection is common in acute-on-chronic liver failure (ACLF), which may worsen the clinical condition and prognosis. However, the characteristics of infection and its influence on prognosis in hepatitis B virus related ACLF (HBV-ACLF) as defined by the European Association for the Study of the Liver (EASL) have not been clarified. We aimed to investigate the characteristics of infection and its influence on mortality in patients with HBV-ACLF defined by EASL in China. Methods We performed a retrospective cohort study in patients with HBV-ACLF defined by EASL in a single center from January 2015 to December 2017. These patients were divided into two groups with and without infection. The incidence, sites of infection, isolated strains, and risk factors associated with mortality were evaluated. Results A total of 289 patients were included, among them 185 (64.0%) were diagnosed with an infection. The most common type of infection was pneumonia (55.7%), followed by spontaneous bacterial peritonitis (47.6%) and others. The gram-negative bacteria were the most frequent (58.3%). Patients with one, two, and three or more infection sites had a gradually increasing incidence of sepsis (P < 0.01), septic shock (P < 0.001), and ACLF-3 (P < 0.05). Also, patients with infection isolated one, two, and three or more strains showed a growing incidence of sepsis (P < 0.01) and septic shock (P < 0.001). Patients with infection showed a significantly higher 28-day mortality than those without (P < 0.01), especially in patients with ACLF-3. Infection was identified as an independent risk factor for 28-day mortality in all HBV-ACLF patients. Pneumonia and sepsis were identified as independent predictors of 28-day mortality for patients with infection. Conclusions Infection is associated with severe clinical course and high mortality in HBV-ACLF defined by EASL. The increased number of infection sites or isolated strains was associated with the occurrence of sepsis and septic shock. Pneumonia and sepsis were independent predictors for mortality in HBV-ACLF patients with infection.


Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Louis Waeckel ◽  
Fabienne Venet ◽  
Morgane Gossez ◽  
Céline Monard ◽  
Thomas Rimmelé ◽  
...  

2019 ◽  
Vol 35 ◽  
pp. 50-54 ◽  
Author(s):  
Michael Manguinao ◽  
Kristen M Krysko ◽  
Sai Maddike ◽  
Alice Rutatangwa ◽  
Carla Francisco ◽  
...  

Critical Care ◽  
2009 ◽  
Vol 13 (4) ◽  
pp. R138 ◽  
Author(s):  
Cédric Daubin ◽  
Philippe Lehoux ◽  
Calin Ivascau ◽  
Marine Tasle ◽  
Mehdi Bousta ◽  
...  

2017 ◽  
Vol 38 (7) ◽  
pp. 1230-1241 ◽  
Author(s):  
Beverley Kok ◽  
Constantine J. Karvellas ◽  
Juan G. Abraldes ◽  
Rajiv Jalan ◽  
Vinay Sundaram ◽  
...  

Critical Care ◽  
2011 ◽  
Vol 15 (4) ◽  
pp. R171 ◽  
Author(s):  
Armand Mekontso Dessap ◽  
Islem Ouanes ◽  
Nerlep Rana ◽  
Beatrice Borghi ◽  
Christophe Bazin ◽  
...  

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